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THE 
NON-SURGICAL 

TREATMENT 

OF 

INTESTINAL  STASIS 

AND 

CONSTIPATION 


Compiled  by 
ROBERT  H.  FERGUSON,  M.D.,  ScD. 


Also  an  Important  Announcement 
Regarding  Liquid  Petrolatum 


Published  for  the  Physician  and  Surgeon  by 

E.  R.  SQUIBB  &  SONS,  NEW  YORK 

Medical  Department 

MCMXVI 


Copyright,  1916,  by 
ROBERT  H.  FERGUSON 


IMPORTANT  ANNOUNCEMENT 

REGARDING 

LIQUID  PETROLATUM 

tP*  ^V  ^V 

For  the  successful  treatment  of  In- 
testinal  Stasis  and  Constipation  by  the 
methods  described  m  the  pages  of  this 
handbook,  the  employment  of  a  mineral 
oil  of  correct  constitution  and  highest 
purity  is  imperative. 

In  pursuance  of  our  long-established 
and  well-known  pohcy  to  supply  of  every 
product  only  the  best  quahty  for  the  pur- 
pose intended,  we  have  made  a  thorough 
and  exhaustive  study  of  all  American 
and  Russian  mineral  oils  obtainable. 
After  more  than  three  years  of  such 
careful  investigation  and  research  we  are 
able  to  announce: 

First:  There  are  two  distinct  types  of 
mineral  oil  for  internal  use  offered  in  the 


4  ANNOUNCEMENT 

market,  differing  greatly  in  physical  and 
in  chemical  properties,  namely: 

(a)  The  heavy  oils,  consisting  princi- 
pally of  the  naphthene  series  of  hydro- 
carbons. These  heavy  oils  are  derived 
only  from  crudes  found  in  California  and 
in  certain  fields  of  Russia. 

(6)  The  light  oils,  consisting  chiefly  of 
the  methane  or  parafiBn  series  of  hydrocar- 
bons. In  this  class  belong  all  American 
mineral  oils  except  certain  ones  of  CaU- 
fornia. 

In  short,  numerous  comparative  tests 
made  by  us  show  the  Californian  heavy 
oil  to  differ  in  essential  respects  from 
other  American  oils  and  also  to  be  su- 
perior to  the  Russian  oils. 

We,  therefore,  have  selected  this  Cali- 
fornian Heavy  Oil  of  high  viscosity  as  the 
best  mineral  oil  obtainable  for  the  in- 
ternal treatment  of  intestinal  stasis  and 
constipation,  and  hereafter  shall  supply 
it  on  all  orders. 

It  is  refined  for  us  under  our  control 
only  by  the  Standard  Oil  Company  of  Cali- 
fornia, which  has  no  connection  with  any 
other  Standard  Oil  Company. 


ANNOUNCEMENT  5 

This  Liquid  Petrolatum  Squibb,  Heavy 
(Calif ornian),  meets  the  quality  specifi- 
cations as  follows: 

It  is  a  water-white,  odorless,  taste- 
less mineral  oil,  consisting  almost  entirely 
of  the  naphthene  series. 

It  has  the  high  specific  gravity*  of 
0.886  to  0^92  at  15^  C.  or  0.881  to  0.887 
at  25°  C. 

It  has  an  exceptionally  high  natural 
viscosity,  t  a  point  of  paramount  impor- 


*  It  is  claimed  that  a  heavy  hydrocarbon  oil  of  high  viscosity 
does  not  pass  as  rapidly  through  the  intestine  as  does  an  oil  of 
lower  gravity  and  viscosity.  This  slower  passage  permits  a 
more  even  distribution  of  the  oil,  a  more  complete  lubrication 
of  the  intestinal  wall,  and  possibly  a  more  thorough  inhibitive 
action  on  bacteria.  Furthermore,  if  a  Hght  oil  of  low  viscosity 
is  used  there  is  leakage  or  dribbling,  while  under  ordinary 
circumstances  no  such  annoyance  is  experienced  when  a  heavy 
oil  of  high  viscosity  is  employed. 


t  In  judging  mineral  oils  by  their  physical  appearance,  it 
should  be  borne  in  mind: 

First :  That  high  viscosity  does  not  necessarily  mean  high 
specific  gravity.  The  former  bears  no  definite  relation  to  the 
latter. 

Secondly :  That  apparent  high  viscosity  may  not  be  true 
viscosity.  Certain  mineral  oils  offered  in  the  market  with 
exaggerated  claims  have  apparently  a  high  viscosity,  but 
upon  testing  show  an  actual  low  viscosity.  Thus,  they  are  in 
fact  not  only  low  in  specific  gravity,  but  also  low  in  viscosi- 
ty, their  appearance  to  the  contrary  notwithstanding. 


6  ANNOUNCEMENT 

tance,  because  true  viscosity  is  the  chief 
index  of  lubricating  power. 

Furthermore,  it  is  a  pure  mineral  oil 
free  from  paraffins,  inorganic  matter,  or- 
ganic sulphur  compounds  and  injurious 
hydrocarbons,  such  as  anthracene,  phen- 
anthrene,  chrysene,  phenols,  and  oxi- 
dized acid  or  basic  bodies. 

It  resists  oxidizing  agents  better  than 
do  the  oils  of  the  methane,  ethylene, 
and  aromatic  series.  It  shows  a  marked 
stability  against  chemical  agents  in  gen- 
eral.    It  is  designated 

Liquid  Petrolatum,  Squibb 

and  sold  solely  under  the  Squibb  label 
and  guaranty.  You  are  respectfully  asked 
to  specify  it  on  your  prescriptions  in 
order  to  make  sure  that  this  Califor- 
nian  oil  of  highest  viscosity  is  furnished. 

E.  R.  Squibb  &  Sons. 


THE  NON-SURGICAL 
TREATMENT  OF 
INTESTINAL  STASIS 
AND  CONSTIPATION 

Compiled  by 

ROBERT   H.  FERGUSON 

M.D.,  ScD. 


FOREWORD 

TTHIS  handbook  is  intended  to  set  forth, 
in  the  briefest  manner  possible,  the 
consensus  of  opinion  of  the  medical  profes- 
sion concerning  the  non-surgical  aspect  of 
the  treatment  of  intestinal  stasis  and  con- 
stipation. It  advances  no  novel  ideas, 
but  brings  together  statements  of  repre- 
sentative physicians  and  surgeons. 

Concerning  certain  aspects  of  the  treat- 
ment Uttle  is  said,  as,  for  instance,  the 
orthopaedic — ^the  choice  of  corsets  if  vis- 
ceroptosis, etc.,  exists;  the  hygienic,  since 
it  varies  so  with  temperament,  time,  and 
place;  also  the  dietary,  which,  too,  is  quite 
individuaHstic.  Enough,  however,  is  ad- 
vanced to  suggest  rational  non-surgical 
treatment,  while  the  accurate  and  com- 
plete bibUography  will  enable  those  more 
deeply  interested  to  consult  the  original 
papers.  Furthermore,  the  full  and  care- 
fully constructed  index  will  give  easy  ac- 
cess to  the  whole. 

Just  here  certain  matters  which  in- 
volve principles  of  scientific  moment,  as 
well  as  of  every-day  practical  medical 

9 


10  FOREWORD 

interest,  should  be  noted.  All  the  au- 
thors recommend  liquid  petrolatum  as 
the  internal  remedy  par  excellence.  How- 
ever, this  product  is  called  by  a  large 
number  of  different  names,  such  as 
"mineral  oil,"  "paraffin  oil,"  "Uquid  paraf- 
fin," "petroleum  oil,"  "liquid  petroleum," 
"Russian  oil,"  "Russian  mineral  oil,"  and 
many  other  designations;  but  in  the  United 
States  only  one  distinctive  name  is  recog- 
nized, the  name  established  by  the  United 
States  Pharmacopoeia.  Therefore,  the 
attention  of  the  Medical  Profession  of 
the  United  States  is  respectfully  called 
to  the  propriety  of  adhering  strictly  to 
the  name  official  in  the  United  States, 
which  is  "Liquid  Petrolatum." 

In  the  United  States,  "paraffin"  means 
the  sohd  wax-Uke  hydrocarbon  so  com- 
monly used  for  candles,  etc.  "Liquid 
paraffin"  is  this  sohd  substance  either 
melted  or  in  solution.  "Petroleum"  and 
"petroleum  oil"  signify  various  forms  of 
more  or  less  crude  earth  oil,  as  kerosene, 
certain  lubricating  oils,  etc. 

To  use,  in  the  United  States,  such 
designations  for  "liquid  petrolatum"  is 


FOREWORD  11 

not  only  confusing  and  misleading,  but 
is  against  the  efforts  of  the  U.  S.  P.  to 
estabhsh  a  definite  nomenclature.  Conse- 
quently, it  should  be  noted  that  the  official 
name  for  the  hydrocarbon  oil  intended 
for  internal  use  is  "Liquid  Petrolatum, 
Heavy." 

In  order  to  avoid  confusion  in  this  hand- 
book, the  TJ.  S.  P.  designation  has  been 
used  instead  of  the  varying  names  em- 
ployed by  the  authors. 

Liquid  petrolatum  is  a  mineral  oil 
which  must  be  distinguished  not  only  in 
its  chemical  composition  but  also  in  its 
physiological  action  from  the  oils  and 
fats  of  vegetable  and  animal  origin. 
These  latter  oils  are  spht  up,  digested, 
and  absorbed  in  the  gastro-intestinal 
tract,  and  serve  various  purposes  in  the 
human  economy. 

Liquid  petrolatum  undergoes  no  change 
in  the  stomach  or  intestines,  It  is  not 
absorbed,  and  it  passes  out  of  the  system 
in  the  same  condition  and  quantity  that 
it  entered.  Its  primary  action  is  entirely 
mechanical,  merely  lubricating  the  lumen 
of  the  gut,   and  keeping  the  intestinal 


12  FOREWORD 

contents  soft.  However,  the  secondary 
effects  of  its  action  are  important,  such 
as  the  reHeving  of  overworked  myenteric 
ganglia  by  allowing  the  intestinal  con- 
tents to  pass  easily;  the  hindering  of 
decomposition  by  preventing  stagnation 
of  the  contents  of  the  bowel;  its  indirect 
bactericidal  action  by  investing  the  bac- 
teria so  completely  as  to  exclude  whatever 
nutriment  is  necessary  for  their  propaga- 
tion; and,  because  of  all  this,  the  permit- 
ting of  a  better  digestion  and  absorption 
of  food  than  are  possible  when  stasis  exists. 

The  criterion  for  judging  a  hquid  petro- 
latum for  internal  use  is  bound  up  with 
the  fact  that  the  primary  action  of  this 
product  is  lubrication.  High  specific 
gravity  is  of  great  value;  and  of  two  oils, 
one  heavy  and  the  other  light,  but  alike 
in  other  respects,  the  heavier  oil,  doubt- 
less, would  be  the  better  for  use  internally. 

However,  the  chief  index  of  lubricat- 
ing power  is  viscosity;  therefore,  a  high 
viscosity  ought  to  be  the  feature  sought 
first,  and  specific  gravity  next;  of  course, 
not  overlooking  "purity y  which  always  is 
essential. 


FOREWORD  13 

The  London  Lancet^  says,  "Since  it  is 
admitted  that  the  value  of  liquid  petrola- 
tiun  taken  internally  is  chiefly  that  of  a 
lubricant  on  the  contents  of  the  bowel 
(although  incidentally  it  may  also  re- 
strict bacterial  activities),  the  viscosity 
of  the  oil  is  probably  a  more  important 
factor.  ...  It  seems  pretty  safe  to  say  that 
the  effects  would  be  quite  different  when, 
on  the  one  hand,  a  rapidly  flowing  oil  is 
used  and,  on  the  other,  an  oil  travelling 
slowly  through  the  digestive  tract.  .  .  . 
Oils  which  flow  more  rapidly  .  .  .  are  less 
Hkely  to  produce  that  steadiness  of 
lubrication  which  is  physiologically  de- 
sirable; they  frequently  produce  intestinal 
pain  and  they  may  even  escape  without 
lubricating  at  all.  Possibly,  also,  the 
disturbing  effect  on  digestion,  which  some- 
times occurs,  is  due  to  the  employment  of 
an  oil  of  too  easy  fluidity." 

In  selecting,  then,  a  suitable  hydro- 
carbon oil  for  internal  administration,  it 
should  be  borne  in  mind  that  choice 
should  be  made  of  a  pure  liquid  petrola- 
tum which  has  not  only  a  high  specific 

1  The  Lancet,  London,  1915,  Oct.  2,  p.  762. 


14  FOREWORD 

gravity i  but  also  a  high  natural  viscosity; 
and  since,  as  The  Lancet  says,  "viscosity 
is  affected  much  more  by  temperature 
than  is  specific  gravity,"  care  should  be 
taken  that  the  oil  has  the  desirable  high 
viscosity  at  body  temperature, 

Robert  H.  Ferguson. 

East  Orange,  N.  J. 


CONTENTS 

PAGE 

Foreword 9 

I.  Importance  of  Intestinal  Stasis     .  17 
II.  Definition  of  Intestinal  Stasis      .  18 

III.  Remote  Effects  OF  Intestinal  Stasis  19 
Watson's  Classification  of  Cases  .  22 

IV.  Cause  of  the  Autointoxication  in 

Intestinal  Stasis 24 

V.  Constipation,  Intestinal  Stasis,  and 

Enteroptosis     .     .     .     .     .     .28 

VI.  Possibility  of  Treating  Intestinal 
Stasis  by  Internal  Lubri- 
cation       .33 

VII.  Wide-Spread  Existence  of  Intestinal 

Stasis 42 

VIII.  NoN- Surgical    Treatment    of    In- 
testinal Stasis 43 

IX.  Constipation  in  Infants   ....  72 

X.  Liquid   Petrolatum   during  Preg- 
nancy AND  Lactation  ....  80 
15 


16  CONTENTS 

PAGE 

XI.  Liquid  Petrolatum  fob  the  Insane  .  82 
XII.  Surgical  Use  of  Liquid  Petrolatum  83 

(a)  As  a  Prophylactic 83 

(6)  For  Diagnosticating  Surgical  from 

Non-surgical  Cases  ....  84 
(c)  Intra-abdominally  to  Prevent  Post- 
Operative     Stasis      (Burrow's 

Method) 85 

Contra-indications  for  the  Intra- 
abdominal Use  of  Mineral  Oil .  90 
{d)  To   Prevent   or   Mitigate   Post- 
Ansesthetic  Nausea  and  Vomit- 
ing   91 

{e)  As  a  Post-Surgical  Laxative  .     .  92 

Index 93 


The  Non-Surgical  Treatment 

of 

Intestinal  Stasis  and  Constipation 

I. 

The  Importance  of  Intestinal  Stasis. 

OcHSNER,2  of  Chicago,  calls  attention 
to  the  fact  that  ^' every  author  of  note, 
from  Hippocrates  to  the  present  day,  who 
has  written  a  treatise  on  medicine,  has 
insisted  on  the  importance  of  preventing 
an  abnormal  accumulation  of  excrement 
in  the  large  intestine,  both  as  a  prophy- 
lactic against  future,  and  as  a  cure  for 
existing,  disease." 

Lane,^  of  London,  says:  *' Chronic  in- 
testinal stasis,  which  I  beheve  to  be  the 
prime  factor  in  the  production  of  very 
many  diseased  conditions,  is  of  enormous 
importance,  and  we  cannot  spend  too 
much  time  or  thought  in  unravelling  the 
many  problems  which  it  presents." 

^  Surgery,  Gynecology  and  Obstetrics,  1916,  Jan.,  p.  44. 
3  British  Medical  Journal,  1912,  May  4,  p.  989. 

17 


18  TREATMENT  OF 

RocKEY/  of  Portland,  Oregon,  says: 
"Careful  clinical  observation  is  convinc- 
ing me,  day  by  day,  that  the  question 
of  intestinal  stasis  and  its  consequent 
morbidity  is  one  of  the  most  important 
subjects  before  the  medical  profession  at 
this  time."  Accordingly,  it  is  well  to 
ask.  What  is  this  important  condition? 

II. 

Definition  of  Intestinal  Stasis. 

No  better  definition  of  intestinal  stasis 
has  been  given  than  that  of  him  who  has 
done  more  than  any  other  to  call  atten- 
tion to  the  fact,  cause,  and  pathology  of 
stasis,  and  has  demonstrated  its  treat- 
ment. "Sir  W.  Arbuthnot  Lane,  whose 
views,  as  Ochsner  says,^  have  been  fully 
supported  by  no  less  famous  a  scientist 
than  Metchnikoff,"  ^  says  ^: 

"By  chronic  intestinal  stasis  I  mean 

*  Surgery,  Gynecology  and  Obstetrics,  1913,  Dec,  p.  737. 

^  Surgery,  Gynecology  and  Obstetrics,  1916,  Jan.,  p.  44. 

^  The  Nature  of  Man,  Part  III,  Chap.  X,  Eng.  trans.,  p. 
248  et  seq. 

The  Prolongation  of  Life,  Part  II,  Chap.  Ill  et  al. 

'  Proceedings  of  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  p.  94;  also 

British  Medical  Journal,  1912,  May  4,  p.  989  et  al. 


INTESTINAL  STASIS  19 

such  an  abnormal  delay  in  the  passage  of 
the  intestinal  contents  through  a  portion 
or  portions  of  the  gastro-intestinal  tract 
as  results  in  the  absorption  into  the  cir- 
culation of  a  greater  quantity  of  poison- 
ous or  toxic  material  than  can  be  treated 
eflFectually  by  the  organs  whose  function 
it  is  to  convert  them  into  products  as 
innocuous  as  possible  to  the  tissues  of  the 
body." 

m. 

Remote  Effects  of  Intestinal  Stasis. 

Lane^  emphasizes  the  fact  that  in- 
testinal stasis  means  more  than  "merely 
the  absence  of  a  daily  action  of  the 
bowels,"  and  that  this  stasis  is  important 
since  "any  delay  in  the  passage  of  the 
contents  of  this  drainage  scheme  has  a 
threefold  result  on  the  organisms  found 
in  the  intestine.  Their  multipHcation  is 
facilitated,  they  extend  beyond  the  Umits 
of  their  normal  habitat,  and  extraneous 
strains  are  developed.  These  organisms 
may  extend  along  the  ducts  of  the  organs 

^Surgery,   Gynecology  and  Obstetrics,   1913,  June,  p.  600 
et  seq. 


20  TREATMENT  OF 

which  open  into  the  drain  pipe,  and  they 
or  their  products,  carried  into  the  blood 
stream,  may  infect  organs  which  do  not 
directly  communicate  with  the  intestine, 
for  example,  the  kidneys,"  producing 
"progressive  degenerative  changes  in 
every  tissue." 

In  this  way,  the  disturbance  caused 
by j^  intestinal  stasis  may  be,  according 
to  ELane,  Bainbridge,  and  others,  most 
extensive  and  important,  yet  apparently 
remote  from  any  connection  with  in- 
testinal toxaemia. 

For  instance,  it  affects  the  ductless 
glands.  RowELL^  in  a  "Discussion  of 
AUmentary  Toxaemia"  before  the  Royal 
Society  of  Medicine,  London,  reported: 
"In  the  case  of  a  very  athletic  young 
lady  of  which  I  have  knowledge,  who 
had  a  large  thyroid  and  some  symptoms 
of  chronic  intestinal  stasis,  after  a  course 
of  Uquid  petrolatum  given  freely  three 
times  a  day  for  ten  days  the  thyroid  had 
diminished  to  less  than  haK  its  former 
size,  and  the  patient  felt  perfectly  well." 

®  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1.  p.  197. 


INTESTINAL  STASIS  21 

Lane*°  operated  on  a  patient  for  in- 
testinal stasis.  He  says:  "For  eight 
years  she  had  suffered  from  an  enlarged 
thyroid  which  projected  forward  in  her 
neck,  and  which  interfered  with  respira- 
tion. It  contained  several  large  adeno- 
mata. .  .  .  Within  a  few  days  after  the 
operation,  it  was  obvious  that  the  thyroid 
was  diminishing  steadily  in  size,  and  this 
diminution  continued  till,  when  she  left 
the  hospital,  it  was  but  Uttle  larger  than 
normal.  I  understand  at  the  present 
time  it  is  not  larger  than  normal." 

"Also  the  nervous  system  is  markedly 
affected."  Further,"  there  may  be  "de- 
generative changes  in  the  breast  associ- 
ated with  stasis,  which  disappear  if  the 
drainage  scheme  be  properly  dealt  with." 

Lane  considers  intestinal  stasis  to  be 
intimately  and  causally  connected  with 
many  cases  of  appendicitis,^^  rheumatoid 

*°  Ptoc.  Royal  Society  of  Medicine,  Vol.  VI,  Part  1,  p.  106. 

^"^  Surgery,  Gynecology  and  Obstetrics,  June,  1913,  pp.  600-606; 
Proceedings  Royal  Society  Medicine,  Vol.  VI,  Part  1,  pp.  96- 
105  (Lane);  p.  197  et  al.  (Rowell);  p.  317  (Clark).  The 
Operative  Treatment  of  Chronic  Intestinal  Stasis,  by  Sir  W. 
AJpbuthnot  Lane,  Sd  Edition,  London,  1915,  pp.  53-68. 

12  British  Medical  Journal,  1911,  Apr.  22,  pp.  913,  914. 


22  TREATMENT  OF 

arthritis,  and  tuberculosis.  As  regards 
the  latter  two,  Lane^^  says:  "In  my  ex- 
perience, a  patient  cannot  develop  either 
of  these  diseases  (except  in  the  case  of 
tubercle  by  inoculation)  unless  the  re- 
sisting power  to  the  entry  of  organisms, 
or,  in  other  words,  the  vitahty  of  the 
tissues  of  the  body,  has  been  depreciated 
by  the  poisons  which  circulate  through 
them  in  chronic  intestinal  stasis." 

Watson^  s  Classification  of  Cases 

Watson,^^  of  Edinburgh,  says:  "Long- 
continued  observation  of  many  cases  of 
chronic  disease,  and  more  especially  pri- 
vate cases  which  I  have  had  the  oppor- 
tunity of  investigating  by  the  aid;iof 
modern  methods  of  diagnosis,  has  led 
me  to  recognize  three  distinct  groups  of 
conditions  that  arise  mainly  or  entirely 
from  intestinal  toxaemia.  .  .  .  (1)  A 
neurasthenic  group.  This  includes  some 
cases  at  present  regarded  as  neurotic, 
and  also  a  sub-group  in  which  the  symp- 

*'  British  Medical  Journal,  1912,  May  4,  p.  989. 
^^  Edinburgh  Medical  Journal  (N.S.)»  1914,  February,  p.  130; 
1914,  March,  p.  220  et  seq.;  1914,  April,  p.  345  et  seq. 


INTESTINAL  STASIS  2S 

toms  are  mainly  mental.  (2)  Rheumatoid 
arthritis.    (3)  A  dyspeptic  group." 

"From  a  therapeutic  standpoint,  cases 
of  intestinal  toxaemia  may  be  roughly 
classified  into  three  main  groups. 

Group  1 :  Cases  in  which  the  symptoms 
are  physical  signs  which  are  comparatively 
trivial  and  which  yield  readily  to  simple 
medical  treatment.  Group  2:  In  which 
the  symptoms  are  more  pronoimced  and 
are  accompanied  by  marked  objective 
indications  of  an  abnormal  state  of  the 
digestive  tract,  but  which  are  amenable 
to  careful  and  prolonged  medical  treat- 
ment. Group  3:  In  which  the  condition 
of  the  digestive  tract  is  so  abnormal 
that  medical  measures  fail  to  relieve; 
rehef  being  obtainable  only  by  surgical 
treatment. 

"Cases  which  fall  under  one  or  other 
of  these  groups  are  met  with  very  com- 
monly in  the  every-day  practice  of  the 
physician,  and  I  am  satisfied  that  they 
form  a  large  share  of  the  cases  which 
come  under  the  daily  observation  of  the 
practitioner." 

The  "keynote  of  successful  treatment 


^  TREATMENT  OF 

is  found  in  the  application  of  antiseptic 
and  aseptic  principles,  rest,  diet,  treat- 
ment of  bowels,"  etc.  .  .  .  *'The  use  of 
liquid  petrolatum  is  of  great  value  as 
a  mechanical  lubricant  in  many  of  these 


cases." 


IV. 

Cause  of  the  Autointoxication  in 
Intestinal  Stasis. 

It  is  of  use  to  note  how  this  auto- 
intoxication has  been  accounted  for. 
Paul  G.  Wooley,^^  of  Cincinnati,  Ohio, 
states  three  possibiUties,  viz.:  Firsts 
that  "  during  digestion  of  food-materials, 
by  the  normal  secretions  of  the  gastro- 
intestinal tract,  toxic  substances  are 
formed,  and  that  these  substances  may 
enter  the  blood  stream  and  produce 
serious  disorders."  Second^  that  "bac- 
teria resident  in  the  intestinal  tract  act 
upon  the  foodstuJBEs  and  produce  toxic 
substances  which  are  absorbed  and  act 
as  intoxicants."  Thirds  that  "the  pres- 
ence of  bacteria  themselves,  which  have 

"  Journal  of  Laboratory  and  Clinical  Medicine,  1915,  Oct., 
pp.  47-49. 


INTESTINAL  STASIS  25 

entered  the  blood  stream  from  the  in- 
testine, is  the  source  of  trouble." 

Dixon  1^  says:  "It  is  by  no  means 
certain  that  true  toxins  are  absorbed 
from  the  intact  mucous  membrane  of 
the  intestinal  canal,"  and,  for  proof,  calls 
attention  to  the  fact  that  snake  venom, 
diphtheria  toxin,  and  tetanus  toxin  are 
harmless  when  taken  by  the  mouth.  He 
adds:  "In  general,  however,  I  think  .  .  . 
that  alimentary  toxaemia  is  poisoning  pro- 
duced not  by  Hoxins '  .  .  .  but  by  rela- 
tively simple  chemical  substances,  cer- 
tainly not  of  a  more  complex  chemical 
nature  than  many  of  the  alkaloids  we 
are  in  the  habit  of  administering.  These 
poisons  are  a  result  of  digestion  or  putre- 
faction of  food    .    .    .    chiefly  proteins." 

Robert  Saundby,^^  however,  explains 
absorption  of  toxins  by  traumatism,  and 
emphasizes  the  importance  of  constipa- 
tion in  autointoxication  on  account  of  its 
causing  lesions  in  the  intestinal  mucosa. 

1®  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  p.  129. 

1^  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  p.  43. 


26  TREATMENT  OF 

He  says:  "Simple  constipation  does  not 
lead  to  any  increase  of  decomposition  in 
the  faeces  .  .  .  but  it  is  a  not  uncommon 
cause  of  chronic  intestinal  catarrh  which 
may  go  on  to  ulceration  and  even  per- 
foration, and  it  is  to  these  inflammatory 
consequences  that  must  be  attributed  the 
varied  symptoms  which  are  associated 
with  constipation/'  and  "nothing  is  more 
certain  than  that  many  symptoms  may 
result  from  constipation  where  altera- 
tions in  the  wall  of  the  bowel  have  taken 
place.  Nor  is  it  inconsistent  with  this 
view  that  thorough  emptying  of  the 
bowel  should  be  followed  by  temporary 
rehef  of  these  symptoms,  but,  at  the  same 
time,  we  should  expect  that  the  simple 
evacuation  of  the  pelvic  colon  would  not 
effect  a  cure." 

N.  Mutch,  ^8  London,  in  his  epoch-mak- 
ing work,  says:  "To  put  the  matter 
briefly,  the  upper  alimentary  tract  is 
speciahzed  for  aseptic  absorption  of  food 

^^  Bacterial  Activity  in  the  Alimentary  Tract — The  British 
Journal  of  Surgery,  Vol.  II,  No.  8,  1915,  April,  pp.  608-638 
(see  p.  609,  also  pp.  623,  624).  The  Lancet  Clinic,  1915, 
August  14,  p.  154;  1915,  August  21,  p.  172. 


INTESTINAL  STASIS  27 

and  the  colon  for  the  bacterial  destruc- 
tion of  residues.  It  is  conceivable  that 
disease  may  arise  from  infection  of  the 
lumen  of  the  upper  alimentary  tract, 
with  the  generation  of  poisonous  decom- 
position products;  or  from  infection 
through  the  walls  of  the  alimentary  canal 
with  discharge  of  bacterial  toxins  into 
the  circulation.  ... 

"  In  all  likelihood,  some  of  the  symp- 
toms experienced  in  constipation  are 
caused  by  bacterial  toxins  generated  in 
the  tissues  of  the  ahmentary  tract  or  even 
in  distant  tissues  infected  through  this 
channel.  Concerning  the  pathogenesis 
of  these  symptoms,  there  is  Uttle  accurate 
evidence  available.  .  .  . 

"Secondary  intestinal  infections,  in 
which  less  usual  organisms  are  in  the 
ileum  in  addition  to  those  commonly 
present  in  intestinal  stasis,  probably 
give  rise  to  many  symptoms  which  must 
be  ascribed  to  the  action  of  bacterial 
toxins  rather  than  to  food-decomposi- 
tion products." 

But   what  Howell*®  says  should  be 

1*  Proc,  Royal  Society  of  Medicine,  Vol.  VI,  Part  1,  p.  196. 


28  TREATMENT  OF 

borne  in  mind,  viz.,  that  "the  exact 
nature  of  the  particular  poison  in  any 
case  is  a  minor  point,  so  far  as  diagnosis 
and  treatment  are  concerned." 

V. 

Constipation,  Intestinal  Stasis, 

AND  EnTEROPTOSIS. 

Saundby^®  calls  attention  to  a  very  im- 
portant matter.  He  says;  "Faecal  re- 
tention is  not  inconsistent  with  a  daily 
action  of  the  bowels";  and 

A.  F.  Hertz  21  emphasizes  this  fact 
when  he  says;  "It  is  well  known  that 
the  frequency  of  the  stools  gives  no  cer- 
tain evidence  as  to  the  existence  of 
intestinal  stasis." 

Sir  W.  Arbuthnot  Lane^^  was  the  first 
to  emphasize  the  importance  of  inter- 
ference with  the  "drainage  scheme"  by 
"obstruction  ...  at  the  points  of  normal 

2°  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  p.  43. 

21  Proceedings  Roycd  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  p.  164. 

22  Surgery,  Gynecology  and  Obstetrics,  1913,  June,  p.  600 
et  seq.;  also  The  Operative  Treatment  of  Chronic  Intestinal 
Stasis,  1st,  2nd,  and  3rd  editions  (London,  1915) . 


INTESTINAL  STASIS  29 

fixation  and  by  kinks  due  to  acquired 
bands."  In  the  dependent  loops  of  intes- 
tine which,  are  formed,  the  intestinal  con- 
tents stagnate  or  move  on  so  abnormally 
slowly  that  fermentation  and  putrefaction 
produce  an  enormously  large  bacterial 
flora,  or  form  toxins  which  by  absorption 
are  distributed  more  or  less  extensively 
throughout  the  body.  It  is  necessary, 
however,  to  bear  in  mind  that  the  im- 
portant fact  is  not  that  of  enteroptosis 
with  or  without  kinks,  but  of  autointoxi- 
cation, whether  there  are  constrictions 
and  a  falhng  of  the  intestines  or  not. 

A.  E.  IlocKEY^^  says:  ''Ptosis  is  un- 
doubtedly a  cause  of  stasis  in  many 
cases;  and  stasis,  by  its  interference  with 
nutrition  and  by  its  mechanical  elonga- 
tions of  the  colon,  is  probably  a  frequent 
cause  of  ptosis.  But  ptosis  is  found  with- 
out stasis,  and  stasis  without  ptosis.  .  .  . 
Many  symptoms,  both  gastric  and  in- 
testinal, ascribed  to  ptosis,  are  symptoms 
of  stasis,  and  clear  up  when  the  stasis  is 
reheved,  and  do  not  necessarily  clear  up 

23  Surgery,  Gynecology  and  Obstetrics,  1913,  Dec.,  p.  737. 


so  TREATMENT  OF 

when  the  ptosis  is  relieved."  So  also 
"stasis  does  not  necessarily  mean  con- 
stipation. There  are  a  few  cases  of 
marked  intestinal  autointoxication  with- 
out constipation." 

J.  N.  Jackson, 2*  of  Kansas  City,  Mo., 
says:  "I  have  seen  a  true  toxic  condition 
without  any  interference  with  peristalsis." 

William  J.  Mayors  says  that  "about 
50  per  cent,  of  the  fluids  and  10  per  cent, 
of  the  soKds"  ingested  by  the  human 
being  "are  absorbed  by  this  (the  first 
half)  of  the  large  intestine.  Beyond  the 
splenic  flexure,  absorption  is  Hmited  in 
amount,  the  bulk  of  absorbable  material 
placed  in  the  rectum  being  promptly 
passed  into  the  proximal  colon  for  ab- 
sorption. 

"It  has  been  shown  by  Bond,^®  Cannon, 
and  others  that  there  is  a  fairly  constant 
antiperistalsis  in  the  large  intestine  which 

^Journal  American  Medical  Association,  1915,  Aug.  28, 
p.  770. 

^American  Journal  of  the  Medical  Sciences,  1913,  Feb., 
p.  157. 

2«  New  Yorh  Medical  Record,  1905,  Aug.  12,  pp.  246-252 
British  Medical  Journal,  1906,  Vol.  II,  p.  238. 


INTESTINAL  STASIS  31" 

passes  material  back  toward  the  csecum. 
.  .  .  'Lyle  has  aptly  compared  its  stor- 
age fmiction  to  the  stomach,'  but  adds 
that,  'unlike  the  stomach,  which  absorbs 
but  a  small  amount,  the  caecum  absorbs 
actively.  In  some  animals  there  is  a 
sphincter  In  the  ascending  colon  to  hold 
the  material  in  the  caecum.  In  man,  a 
marked  physiological  activity  is  shown 
at  this  point,  although  no  colonic  sphinc- , 
ter  exists.'" 

Leslie 27  says:  In  intestinal  stasis  "the 
pelvic  colon  and  rectum  may  become 
greatly  elongated  (perhaps  as  much  as 
twice  the  normal  length),  sagging  along 
the  floor  of  the  true  pelvis,  and  capable 
of  retaining  the  faecal  matter  for  several 
days,  even  though  a  small  piece  may  be 
broken  off  and  evacuated  daily,  thus 
giving  rise  to  a  false  impression  of  bowel 
regularity.  There  may  even  be  irritating 
diarrhea — *the  diarrhea  of  constipation. ' " 

It  is  admitted,  then,  that  in  many  ways 
during  the  passage  of  the  contents  of  the 
intestine,  and  at  many  places  en  route, 
bacteria  and  toxins  are  produced   and 

**  American  Practitionery  August,  1913,  p.  410. 


32  TREATIMENT  OF 

may  be  absorbed  with  more  or  less  serious 
results  to  the  individual.  Since  this  is 
so,  the  summary  of  Bainbridge^^  is  well 
made.  He  says:  "Lane  .  .  .  has  demon- 
strated clearly  that  in  health  mainte- 
nance, the  question  of  prime  importance 
is  body  drainage — ^the  non-absorption  of 
poisons  and  the  ehmination  of  whatever 
poisonous  matter  may  be  produced  within 
the  ahmentary  canal  before  there  has 
been  inaugurated  a  vicious  cycle  of  events 
which  may  be  the  forerunner  of  disas- 
trous end  results." 
:■  That  this  importance  of  "body  drainage' ' 
is  not  exaggerated  is  evident  from  the 
experiments  of  Carrel^^  and  others  at 
the  Rockefeller  Institute  for  Medical 
Research  and  at  the  Laboratories  of  the 
New  York  Lying-in  Hospital.^''       These 

**  Maine  Medical  Journal,  1913,  July. 

29  Journal   American   Medical   Association,    1911,    Jan.    7, 
pp.  32,  33;  1911,  Nov.  11,  p.  1611;  1912,  Aug.  17,  pp.  523-527. 

Studies  from  the  RockefeUei  Institute,  18,  1914,  pp.  344-349. 

Journal  Exp.  Med.,  1913,  Jan.,  pp.  14-19. 

^  Caerel  and  Montrose  T.  Burrows,  Journal  American 
Medical  Association,  1910,  Oct.  29,  p.  1554. 

Carrel  and  Montrose  T.  Burrows,  Journal  Exp.  Med., 
1911,  Vol.  Xin,  No.  4,  pp.  562-570. 

A.  Carrel,  Journal  Exp.  Med.,  1912,  Vol.  XV,  No.  5, 
pp.  51&-528. 


INTESTINAL  STASIS  33 

experiments  show  **that  decay  is  due  to 
an  inability  of  the  tissues  to  eliminate 
waste  products." 

Also  "that  under  the  conditions  and 
within  the  limits  of  the  experiments, 
seniUty  and  death  are  not  a  necessary, 
but  merely  a  contingent,  phenomenon." 
It  is  this  removal  of  general  body  waste, 
and  particularly  the  prevention  of  addi- 
tions to  the  effects  of  normal  waste 
throughout  the  body  consequent  upon 
the  absorption  by  the  intestine  of  toxins 
formed  on  account  of  the  hindrance  to 
normal  elimination,  that  is  the  aim  of 
the  treatment  of  stasis.  The  result  is  a 
renewed  and  prolonged  vitality  of  general 
body  tissue." 

VI. 

Possibility  of  Treating  Intestinal 
Stasis  by  Internal  Lubrication. 

The  question  now  arises:  Can  intes- 
tinal stasis  be  treated  by  non-surgical 
means,  with  any  assurance  of  success? 

^  a.  Carrel,  Journal  Exp.  Med.,  1914,  Vol.  XX,  No.  1, 
pp.  1-2. 

LosBE  AND  Ebbmng,  Joumal  Exp.  Med.,  1914,  Vol.  XIX. 
No.  6,  pp.  593-602. 


34  TREATMENT  OF 

The  answer  of  both  surgeons  and  phy- 
sicians is  an  unequivocal  "Yes,"  provided 
a  proper  selection  is  made  of  advanced 
cases,  and  incipient  or  mild  cases  be  cared 
for  promptly;  also  Uquid  petrolatum  is 
the  remedy  to  be  rehed  upon,  and  should 
be  tried  before  deciding  on  surgical  means, 
provided  the  product  employed  is  of  the 
required  purity,  high  specijBc  gravity,  and 
high  natural  viscosity. 

Lane 31  says:  "We  find  some  difficulty 
in  drawing  the  line  between  the  cases  in 
which  the  stasis  can  be  efficiently  met 
by  the  use  of  Kquid  petrolatum  and  those 
in  which  an  alteration  in  the  drainage 
scheme  is  advisable.  In  all  doubtful 
cases  we  give  Kquid  petrolatum  a  thor- 
ough trial  before  adopting  operative  pro- 
cedures." 

William  S.  Bainbridge ^^  says:   "The 

30  LosEE  AND  Ebeling,  Joumol  Exp.  Med.,  1914,  Vol.  XX, 
No.  2,  pp.  14Q-148. 

A.  H.  Ebeling,  Journal  Exp.  Med.,  1913,  Vol.  XVII, 
No.  3,  pp.  273-285. 

A.  H.  Ebeung,  Journal  Exp.  Med.,  1914,  Vol.  XX,  No.  2 
pp.  130-139. 

31  British  Medical  Journal,  May  4,  1912,  p.  989 

32  New  York  Medical  Journal,  1914,  Jan.  24. 


INTESTINAL  STASIS  35 

vast  majority  of  cases  should  have  been 
prevented.  Hygienic  and  medical  treat- 
ment will  cure  a  large  proportion  of  cases 
if  instituted  in  the  beginning.  Certainly, 
nine  out  of  ten,  and  possibly  nineteen 
out  of  twenty,  of  all  cases  should  not 
reach  the  stage  which  calls  for  surgical 
intervention." 

Lane 33  says:  "From  the  surgeon's 
point  of  view,  the  treatment  of  chronic 
intestinal  stasis  consists  in  f acihtating  the 
passage  of  material  through  the  several 
portions  of  the  gastro-intestinal  tract. 
...  In  the  vast  majority  of  cases,  the  use 
of  a  lubricating  material,  such  as  Uquid 
petrolatum,  which  precedes  the  passage  of 
food,  appHcation  of  some  spring  support 
to  the  lower  abdomen,  which  tends  to 
keep  the  viscera  up  and  to  control  the 
delay  of  material  in  the  small  intestine 
and  caecum,  and  the  avoidance  of  the  use 
of  such  proteid  foods  as  poison  the  tissues 
if  retained  for  an  abnormally  long  time  in 
the  intestine,  are  sufficient  for  the  pur- 
pose." 

53  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  p.  114. 


36  TREATMENT  OF 

R.  Murray  Leslie^  says:  "In  the 
large  majority  of  instances,  if  the  cases 
are  treated  at  a  comparatively  early 
stage,  simple  remedial  measures  such  as 
diet  modifications,  physical  exercises,  ab- 
dominal massage,  supporting  belts,  ape- 
rient remedies,  and  lubricants  (such  as 
liquid  petrolatum)  are  usually  quite  eflBca- 
cious.  .  .  .  Liquid  petrolatum  ought  to 
be  given  in  large  doses  Q/^  to  1  ounce) 
two  or  three  times  daily." 

William  Van  V.  Hayes ^^  says:  "Sur- 
gery should  not  be  thought  of  in  the  great 
majority  of  instances,  but  is  indicated  in 
the  marked  cases  failing  to  respond  to 
persistent  competent  medical  treatment." 

A.  F.  Hertzes  says:  "In  those  cases  in 
which  the  whole  of  the  colon  is  involved, 
medical  treatment  almost  invariably  suc- 
ceeds." 

Robert  C.  Coffey^^  writes:  "The 
large  majority  of  cases  of  ptosis  may  be 

^^  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  p.  272. 
35  New  York  Medical  Journal,  1914,  Feb.  28,  p.  172. 
^Proc.  Roy.  Soc.  Med.,  London,  Vol.  I,  Part  6,  p.  175. 
37  Surgery,  Gynecology  and  Obstetrics,  1913,  Dec.,  p.  428. 


INTESTINAL  STASIS  37 

successfully  treated  and  the  patient  made 
perfectly  comfortable  by  medical  and 
dietary  measures.  Surgery  should  never 
be  considered  for  the  treatment  of  ptosis 
per  se.  Gastric  or  intestinal  stasis  not 
relieved  by  medical  and  dietary  measures 
constitutes  the  only  excuse  for  surgery 
in  this  class  of  cases."  .  .  .  "I  wish  to 
reiterate  that  only  a  very  small  per  cent, 
of  ptosis  cases  as  they  now  come  to  the 
doctor  are  surgical." 

W.  B.  Russ,^^  of  San  Antonio,  Texas, 
says:  "Cases  of  intestinal  stasis,  even 
though  infection  and  toxaemia  are  pres- 
ent, are  primarily  not  surgical  cases;  and, 
if  the  patients  are  properly  treated,  very 
few  need  ever  become  surgical." 

Rea  Smith,  ^^  of  Los  Angeles,  Cali- 
fornia, says:  "I  wish  particularly  to 
endorse  the  statement  of  Russ,  that  most 
cases  of  intestinal  stasis  are  medical,  and 
I  agree  that  operation  should  be  reserved 
for  medical  failures." 

^^  Journal  American  Medical  Association,  1915,  Aug.  28, 
p.  769. 

^^  Journal  American  Medical  Association,  1915,  Aug.  28, 
p.  770. 


38  TREATMENT  OF 

J.  H.  Kellogg,^  of  Battle  Creek, 
Michigan,  says  he  "feels  that  his  ex- 
perience has  demonstrated  that  by  the 
systematic  use  of  liquid  petrolatum,  com- 
bined with  a  laxative  and  antitoxic 
dietary,  a  very' large  proportion  of  the 
cases  now  subjected  to  short  circuiting  and 
other  operations  might  escape  surgical 
interference  altogether;  certainly  a  thing 
greatly  to  be  desired,  especially  since  we 
do  not  yet  know  what  may  be  the  remote 
effects  of  these  operations,  while  we  do 
know  that  the  immediate  results  are 
often  far  from  satisfactory." 


<c 


N.  W.  JoNEs,4i  Portland,  Ore.,  writes: 
No  patient  should  ever  be  operated 
upon  until  a  local  barrier  of  surgical 
degree  has  been  determined  as  such  by 
the  failure  of  medical  measures." 

W.  Hale  White  ^^  believes  the  general 
practitioner  can  prevent  intestinal  stasis. 
He  told  the  Royal  Society  of  Medicine, 
London,  that  in  intestinal  stasis  ''if  sur- 

^  New  York  Medical  Journal,  1914,  Sept.  12,  p.  508. 

*i  Lancet  Clinic,  1915,  Dec.  4,  p.  495. 

^  Proc.  Roy.  Sac.  Med.,  Vol.  I.  Part  6.  p.  9. 


INTESTINAL  STASIS  SO 

gical  Interference  is  ever  necessary  the 
patient  for  whom  it  is  necessary  is  a  re- 
proach to  her  doctors,  if  she  has  con- 
sulted any  in  the  earher  period  of  her 
illness,  for  the  condition  never  ought  to 
be  allowed  to  advance  to  the  stage  which 
requires  surgery." 

In  this  connection,  the  words  of  Ochs- 
NER,^^  of  Chicago,  Illinois,  are  significant. 
He  says:  "During  ...  1914  ..  .  the 
cases  operated  upon  by  my  colleague  .  .  . 
and  myself  .  .  .  represent  less  than  10 
per  cent,  of  all  the  cases  which  came  under 
our  care  during  this  period  for  the  relief 
of  intestinal  stasis,  and  still  the  number 
operated  upon  contains  some  cases  which 
should  not  have  been  treated  surgically."* 
He  gives  ^^  as  "contra-indications  to  sur- 
gical treatment"  "the  class  of  neurotics 
whose  nervous  condition  has  not  been 
caused  by  intoxication  due  to  intestinal 
stasis,"  also  "in  all  instances  where  care- 
ful and  long-continued  hygienic,  dietetic, 
and  medicinal  treatment  results  in  physio- 
logical relief."  ^  After  these  cases  are  ruled 

\*3  Surgery,  Gynecology  and  Obstetrics,  1916,  Jan.,  p.  45. 
**  Surgery,  Gynecology  and  Obstetrics,  1916,  Jan.,  pp.  47,  48. 


40  TREATMENT  OF 

out,  "only  a  very  small  percentage  of 
patients  suffering  from  intestinal  stasis 
will  remain  who  need  to  be  considered 
from  the  surgical  standpoint." 

Aboiit  three  years  ago,  the  Royal 
Society  of  Medicine  in  London,  England,  ^^ 
had  "A  Discussion  on  Ahmentary  Tox- 
semia:  Its  Sources,  Consequences,  and 
Treatment."  The  reading  of  papers  and 
the  debate  occupied  six  sessions  on  as 
many  days  in  three  consecutive  months. 
It  was  a  very  exhaustive  consideration  of 
intestinal  stasis,  and  commanded  the  best 
medical,  surgical,  and  dental  talent.  The 
printed  part  of  this  discussion  fills  380 
royal  octavo  pages.  At  the  closing  of 
the  sessions,  W.  Hale  White,^^  in  making 
the  summary  of  all  that  had  been  set 
forth,  said:  "It  is  agreed  that  in  the 
vast  majority  of  cases  medical  treatment 
suffices,  and  what  has  been  said  about 
treatment  in  this  discussion  has  come 
chiefly  from  the  surgeons.  ...  If  the 
cases  that  now  seem  to  some  to  justify 

^  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  1913,  March,  April,  May,  pp.  1-380 

^  Proceedings  Royal  Society  of  Medicine,  London.  Vol.  VI, 
Part  1,  p.  380. 


INTESTINAL  STASIS  41 

surgical  treatment  had  been  treated  in 
the  first  stages  by  proper  medical  means, 
surgical  interference  would  not  have  been 
necessary,  so  that  when  this  is  widely 
appreciated,  cases  ought  never  to  become 
so  severe  that  surgical  treatment  is  con- 
templated, and  we  may  hope  one  result 
of  this  discussion  will  be  that  we  shall 
keep  the  drainage  scheme  of  our  patients 
in  sufficiently  good  order  as  to  render 
surgical  interference  unnecessary." 

And,  similarly,  A.  J.  Ochsner,*'  after 
saying  that  intestinal  stasis  occurs  ''in 
patients  who  have  suffered  severely  from 
digestive  disturbances  during  infancy, 
with  severe  gaseous  distension  of  the 
intestines,"  adds,  '*it  seems  as  though 
not  only  the  toxic  conditions  but  that  the 
cause  of  these  conditions  should  be  met 
by  proper  prophylaxis  before  the  support 
of  the  intestines  and  the  muscular  struc- 
ture have  been  permanently  injured.  It 
would,  consequently,  seem  proper  to 
credit  the  pediatrician  and  the  general 
practitioner   with   the   elimination   of   a 

*^  Surgery t  Gynecology  and  Obstetrics,  1916,  Jan.,  pp.  46,  47. 


42  TREATMENT  OF 

great  part  of  suffering  from  this  cause 
in  the  future." 

VII. 

The  Wide-Spread  Existence  of 
Intestinal  Stasis. 

The  existence  of  intestinal  stasis  and 
the  condition  of  ahmentary  toxaemia  are 
much  more  common  than  might  seem  to 
be  the  case  on  first  thought. 

N.  W.  JoNES,^^  of  Portland,  Oregon, 
says  that  "fifty  per  cent,  of  all  people 
possess  the  general  asthenic  type  of 
build,"  that  "within  this  type  .  •  .  lies 
.  .  .  the  potentiality  for  general  body 
weakness  which  determines  •  .  .  the 
morbid  symptoms  attributed  to  ptosis." 
"Only  when  mechanical  or  toxic  symp- 
toms occur  ...  do  patients  realize  that 
they  are  not  well."  "No  patient  should 
ever  be  operated  upon  until  a  local  barrier 
of  surgical  degree  has  been  determined 
as  such  by  the  failure  of  .  .  .  medical 
measures."  These  are  orthopaedic,  hy- 
gienic and  dietary,  and  the  internal  ad- 
ministration  of  liquid   petrolatum.     He 

«8  Lancet  ClirdCt  1915,  Dec.  4,  pp.  494-495. 


INTESTmAL  STASIS  43 

says:  "When  the  stasis  is  severe,  and 
especially  when  it  concerns  local  ileum 
or  caecum  blocking,  the  patient  must  be 
put  to  bed  under  control,  and  the  bowel 
filled  as  rapidly  as  possible  with  a  soft 
vegetable  pulp  and  a  variable  amount  of 
Uquid  petrolatum." 

It  is  evident  that  there  is  a  very  general 
belief  that  intestinal  stasis  can  be  treated 
medicinally.  Ochsner's  ^^  experience 
shows  how  small  a  per  cent,  of  cases  of 
intestinal  stasis  is  surgical,  and  Wat- 
son's ^°  careful  observations  lead  him  to 
say  that  cases  which  come  under  his 
grouping  "are  met  with  very  commonly 
in  the  every-day  practice  of  the  physi- 
cian," and  he  is  satisfied  that  such  cases 
"form  a  large  share  of  the  cases  which 
come  under  the  daily  observation  of  the 
practitioner." 

vin. 

The  Non-Surgical  Treatment  of 

Intestinal  Stasis. 
Considering   diseases    in   general,  the 
question  of  treating  any  one  case  is  often 

*^  Surgery,  Gynecology  and  Ohstdrics,  1916,  Jan.,  pp.  54-57. 
50  Edinburgh  Medical  Journal,  1914,  April,  p.  346. 


44  TREATMENT  OF 

perplexing,  since  not  only  the  various 
schools  of  medicine  dififer  widely  in  their 
ideas  of  medication,  but  also  because  the 
individual  members  of  each  school  fre- 
quently have  so  different  preferences. 
Happily,  however,  as  regards  the  treat- 
ment of  intestinal  stasis  there  is  great 
unanimity  of  opinion.  Proper  diet,  ra- 
tional hygiene,  a  suitable  abdominal  sup- 
port, and  Uquid  petrolatum  constitute  the 
non-surgical  treatment.  Cases  should  be 
cared  for  non-surgically  at  first  and  until 
such  treatment  has  been  found  inefficient. 
Most  cases,  however,  yield  to  it  if  it  is 
carried  out  with  patience  and  persistence. 
The  internal  non-surgical  remedy  "par 
excellence  is  heavy  Hquid  petrolatum. 

William  Van  V.  Hayes"  says:  "In 
the  way  of  medication,  bland  laxatives 
are  the  chief  medicine  to  be  used,  with 
Hquid  petrolatum  of  superior  quaUty 
occupying  the  first  place  in  usefulness. 
This  product  has  the  property  of  render- 
ing the  stools  more  soft  and  of  hastening 
the  movement  of  the  food  through  the 

51  New  York  Medical  Journal,  1914,  Jan.  24,  p.  172. 
New  York  Medical  Record,  1914,  Feb.  28,  p.  410. 


INTESTmAL  STASIS  45 

small  and  large  intestine.  It  is  not 
always  sufficient  by  itseK,  however,  and 
must  be  assisted  by  agar-agar,  phenol- 
phthalein,  compound  licorice  powder,  a 
saline  cathartic,  or  cascara.  Colocynth, 
podophyllin,  and  similar  drugs  should  not 
be  used  because  of  their  irritant  action." 

J.  BiON  BoGART^^  considers  it  best 
to  attack  the  Goliath  at  its  source,  the  Ueal 
affluent;  and  if  the  symptoms  are  unre- 
lieved by  a  course  of  genuine  Hquid  petro- 
latum there  is  nothing  left  but  ileo- 
sigmoidostomy  with  or  without  colectomy. 

Sir  W.  Arbuthnot  Lane^^  says:  "As 
to  treatment,  it  resolves  itseK  into  the 
operative  and  non-operative.  The  non- 
operative  treatment  consists  in  facihtat- 
ing  the  passage  of  material  through  the 
gastro-intestinal  tract  by  sufficient  doses 
of  liquid  petrolatum  and  by  the  pressure 
exerted  on  the  lower  abdomen  by  a 
spring  support." 

Such  treatment  is  of  very  great  value 
where  the  stasis  is  general  through  the 

52  New  York  Medical  Journal,  1914,  Feb.  28,  p.  413. 
63  British  Medical  Jcnimal,  1912,  May  4,  p.  993. 


46  TREATMENT  OF 

drainage  scheme  or  when  the  passage 
through  part  or  the  whole  of  the  large  in- 
testme  is  obstructed.  He  condemns  the 
use  of  germicidal  drugs;  tonics,  as  iron, 
arsenic,  and  mercury;  purgatives;  the  re- 
striction of  food;  large  quantities  of  water 
by  mouth;  massage;  gastric  lavage  and 
bowel  flushing.  He  says^*:  "All  these 
forms  of  treatment  are  tedious,  danger- 
ous, and  at  the  best  only  palhative. 
Much  more  benefit  can  be  obtained  by  the 
use  of  pure  liquid  petrolatum  adminis- 
tered at  regular  intervals  during  the  day. 
It  cannot  be  absorbed  in  the  human 
intestines,  while  it  facilitates  very  materi- 
ally the  passage  of  the  intestinal  contents. 
The  motions  cease  to  be  firm,  and  they 
are  much  less  bulky  than  before,  for  the 
reason  that  the  amount  of  organisms, 
which  forms  a  considerable  proportion  of 
normal  faeces,  is  greatly  reduced."  In 
addition,  he  recommends  "the  use  of  a 
spring  support  controlling  the  lower  ab- 
domen," and  says,  "This  treatment  is 

5*  Surgery,  Gynec.  and  Obstetrics,  1913,  June,  p.  604  et  seq. 

Also  see  The  Operative  Treatment  of  Chronic  Intestinal  Stasis, 
3d  ed.,  London,  1915,  pp.  69-71.  Cf.  also  Strasburger's  opinion; 
The  Prolongation  of  Life,  by  Elie  Metchnikoff,  Eng.trans.,  p.  157. 


INTESTINAL  STASIS  47 

adequate,  providing  the  mechanical  ob- 
struction produced  by  one  or  more  kinks 
is  not  too  great."  "In  the  shghter 
degrees  of  obstruction,  the  use  of  an 
abdominal  support  and  a  sufficient  dose 
of  Kquid  petrolatum  is  enough  to  coimter- 
act  any  defect  in  the  drainage.  The 
abdominal  support  not  only  keeps  up 
the  viscera,  but  it  prevents  the  blood 
puddhng  in  the  large  veins  in  the 
mesentery." 

"Just  how  liquid  petrolatum ^^  acts  is 
not  perfectly  clear.  In  animals  it  de- 
stroys the  worms  that  infest  the  intestinal 
tract  and  such  parasites  as  hve  on  their 
skin.  The  eggs  of  ascaris  lumh'icoides, 
which  will  go  on  dividing  in  glacial  acetic 
acid,  when  placed  in  hquid  petrolatum 
die  and  no  division  takes  place;  and  skin 
mycosisy  in  a  large  bird  which  resisted 
treatment  with  iodine,  has  been  cured  by 
daily  applications  of  hquid  petrolatum 
forcibly  rubbed  in.  It  also  cures  the 
dysenteric  conditions  to  which  animals 
are  so  hable,  especially  in  captivity.  Yet 
liquid  petrolatum  is  apparently  perfectly 

55  Guy's  Hospital  Gazette,  1911,  Sept.  30,  p.  404. 


48  TREATMENT  OF 

innocuous  to  the  human  subject,  and 
loses  none  of  its  bulk  in  its  passage 
through  the  intestinal  tract." 

"The  non-operative  treatment  of 
stasis,^®  then,  consists  in  facilitating  the 
passage  of  material  through  the  gastro- 
intestinal tract  by  sufficient  doses  of 
hquid  petrolatum  and  by  the  pressure 
exerted  on  the  lower  abdomen  by  a  spring 
support."  .  .  .  Even  in  cases  of  "serious 
obstruction  at  the  end  of  the  ileum,  or 
when  the  lumen  of  the  duodenum  is 
reduced  very  considerably  by  cicatriza- 
tion of  an  ulcer,  it  (liquid  petrolatum)  is 
often  very  helpful  in  facilitating  the 
passage  of  the  fluid  contents  through  a 
small  aperture.  .  .  .  The  use  of  liquid 
petrolatum  reduces  the  quantity  of  faecal 
matter  passed,  very  considerably,  prob- 
ably because  it  is  hurried  along  the  tract 
and  has  not  added  to  it  the  large  quantity 
of  organisms  which  form  so  much  of  its 
bulk  in  normal  conditions.  The  quantity 
of  urine  passed  is  also  much  reduced, 
apparently  because  the  hustling  of  the 
faecal  contents  along  the  canal  reduces 

^  British  Medical  Journal,  1912,  May  4,  p.  993. 


INTESTINAL  STASIS  49 

greatly  the  quantity  of  toxins  absorbed 
by  the  mesenteric  vessels  and  the  products 
into  which  they  are  converted  in  order  to 
be  excreted  through  the  kidneys,  etc." 

R.  Murray  Leslie"  says:  "During 
the  past  year  I  have  been  struck  with 
the  undoubted  benefits  from  the  regular 
use  of  Uquid  petrolatum  in  cases  of  en- 
teroptosis,  even  when  accompanied  by 
well-marked  chronic  intestinal  stasis.  .  .  . 
I  generally  begin  with  doses  of  two  tea- 
spoonfuls  twice  or  thrice  daily,  and  in 
some  cases  increase  to  one  tablespoonful 
doses.  During  the  administration  of 
liquid  petrolatum,  aperient  drugs  may 
often  be  almost  entirely  suspended,  which 
is  a  great  advantage.  In  addition  to  its 
lubricant  action,  hquid  petrolatum  seems 
to  exercise  a  most  beneficial  effect  on  the 
intestinal  mucous  membrane,  and  its 
value  in  many  cases  of  mucous  coHtis  is 
quite  remarkable." 

A.  E.  RocKEY^  says:  *'The  dryness  of 
the  colonic  contents  may  be  avoided  by 

•'  Clinical  Journal,  1912,  May  1,  p.  61. 

»•  Surgery,  Gynecology andOhstetrics,  1913,  Dec.,  pp.746-747» 


50  TREATMENT  OF 

causing  the  patient  to  drink  large  quan- 
tities of  water.  .  .  .  Liquid  petrolatum 
is  the  most  effic  ?nt  lubricant  for  the  colon 
that  can  be  given  by  the  mouth.  ...  A 
dose  of  from  one  to  three  ounces,  given 
preferably  in  a  glass  of  cold  water,  at 
night,  is  sufficient  to  overcome  many  ob- 
stinate cases  of  constipation  during  the 
time  that  it  is  used.  As  the  mechanical 
causes  of  the  constipation  are  not  in- 
fluenced by  the  use  of  this  remedy,  it  may 
be  necessary  to  continue  it  indefinitely, 
and  it  is  far  better  to  give  a  daily  dose  of 
just  sufficient  size  to  produce  a  regular 
movement  than  to  cause  a  spasmodic 
movement  by  the  use  of  a  large  dose  for 
the  purpose  of  clearing  accumulations." 

Gerald  Blake ^^  writes:  "The  medical 
treatment  (of  ileal  stasis)  resolves  itself 
into  an  attempt  to  restore  the  inefficient 
bowel  to  its  normal  function.  Rehef  of 
constipation,  over  a  long  period  of  time, 
may  of  itself  be  a  curative  measure,  and 
this  has  been  best  accomplished  by  the 
use  of  some  of  the  mechanical  agents  for 
moving    the    bowels,    preferably    liquid 

68  Boston  Medical  and  Surgical  Journal,  1914,  Mar.  19,  p.  423. 


INTESTINAL  STASIS  51 

petrolatum  in  one-half-ounce  doses  two 
or  three  times  a  day,  or  agar-agar  in  two- 
dram  doses  three  times  a  day,  or  both 
together,  with  a  diet  aimed  at  relief  of 
constipation,  and  general  hygienic  and 
tonic  measures  to  strengthen  the  weak- 
ened tissues." 

R.  Murray  Leslie®^'  says:  "Liquid 
petrolatum  is  extremely  useful  as  a 
routine  remedy  in  the  treatment  of  or- 
dinary constipation  apart  from  actual 
stasis,  particularly  when  associated  with 
flatulence  or  distension;  while  the  value 
of  its  lubricant  action  in  the  case  of 
hemorrhoids  is  obvious." 

Quite  recently,  A.  L.  Knight^^  called 
the  attention  of  the  Academy  of  Medi- 
cine of  Cincinnati  to  the  value  of 
Keith's  work,  which  shows  the  important 
connection  of  the  myenteric  or  Auer- 
bach's  plexus  with  intestinal  stasis. 
This  plexus  *'has  the  power  of  main- 
taining tonicity,  of  originating  and  con- 
ducting impulses,  and  of  reacting  in  a 

^  American  PracUtioner,  1913,  Aug.,  p.  422. 
81  Lancet  Clinic,  1915,  Dec.  4,  p.  491  et  seq» 


52  TREATMENT  OF 

specific  manner  to  specific  stimuli.  .  .  . 
There  are  points  in  the  digestive  tract 
where  the  tissue  is  particularly  well 
developed,  and  from  which  peristaltic 
movement  seems  to  originate — ^that  is, 
points  that  are  true  nodal  centers  or 
pace-makers,  notably,  at  least  anatomi- 
cally, that  center  at  the  ileo-csecal  junc- 
tion." 

Arthur  Keith  62  demonstrates  "that 
Auerbach's  plexus  (or  more  exactly  the  tis- 
sue which  unites  the  plexus  with  the  mus- 
culature of  the  bowel — ^Auerbach's  tissue) 
represents  the  most  excitable  musculature 
of  the  intestine"  and  is  of  the  same  nature 
as  the  auriculo-ventricular  bundle  of  His. 
"Tawara  regarded  the  nodal  tissue  at  the 
commencement  of  that  bundle  as  excitory 
in  nature — muscular  tissue  with  an  en- 
hanced power  of  initiating  rhythmic  con- 
tractions. ...  It  is  this  intermediate 
tissue    which    is    particularly    endowed 

62  An  Account  of  Six  Specimens  of  the  Great  Bowel  Re- 
moved by  Operation:  With  Some  Observations  on  the  Motor 
Mechanism  of  the  Colon,  by  Arthur  Keith,  London,  in  The 
British  Journal  of  Surgery ^  Vol.  H,  No.^8,  1915,  April,  pp.  576- 
599; — also  see  The  Cavendish  Lecture,  1915,  Jime  25.  See 
The  Lancet  (London),  1915,  August  21,  pp.  371-375,  also 
1915,  July  3,  pp.  18,  19. 


INTESTINAL  STASIS  53 

,••.•■  •  -•  ■  ■^..  ^ 

with  an  automatic  power  of  originating 
contractile  impulses  and  muscular  move- 
ments. .  .  .  Auerbach's  collar,  which  sur- 
rounds the  ileo-caecal  junction,  is  'nodal' 
in  its  true  nature;  it  is  the  tissue  in 
which  csecal  and  ileo-csecal  movements 
normally  take  their  origin;  and  it  is 
through  this  tissue  that  the  central 
nervous  system  exercises  its  control  over 
such  movements."  He  finds  Auerbach's 
plexus  and  tissue  particularly  developed 
at  the  pylorus — ^the  junction  of  the  duo- 
denum and  jejunum — ^the  ileo-csecal  junc- 
tion of  the  proximal  and  distal  colon  as 
well  as  of  the  colon  and  rectum.  *'Inthe 
distal  part  of  the  transverse  colon  and  in 
the  descending  colon — ^these  tracts  of  the 
bowel  being  normally  in  a  condition  of 
hypertonus — ^this  tissue  is  more  abun- 
dant than  in  the  appendix,  caecum,  or 
ascending  colon."  He  says:  "I  am  con- 
vinced that  in  the  great  majority  of 
cases  which  are  classified  under  the  some- 
what elastic  term  of  '  intestinal  stasis'  the 
symptoms  do  not  result  from  an  atony  of 
the  musculature  of  the  bowel,  but  from 
a  hypertonicity  of  those  parts  which  are 


54  TREATMENT  OF 

normally  in  a  state  of  tonic  contrac- 
tion. .  .  . 

"There  is  no  doubt  that  in  all  cases  of 
intestinal  stasis  there  is  a  disorder  of  the 
neuro-muscular  mechanism  of  the  great 
bowel,  but  we  cannot  explain  that  dis- 
order in  the  present  state  of  our  knowl- 
edge." 

Nevertheless,  from  this  it  is  easy  to 
understand  the  value  of  liquid  petrola- 
tum in  all  degrees  of  intestinal  stasis,  es- 
pecially in  incipient  stasis.  The  oil  pre- 
vents the  intestinal  contents  irritating  the 
intestinal  wall,  while,  at  the  same  time, 
it  allows  the  contents  to  pass  easily  and 
quickly  along.  It  relieves  the  exhausted 
or  weakened  myenteric  ganglia  to  the 
extent  that  ultimately  a  normal  bowel 
functioning  may  result.  Or  it  may  faciU- 
tate  the  passage  of  the  intestinal  contents 
through  a  bowel  in  tonic  spasm  whether 
such  is  due  to  central  or  peripheral 
stimulation. 

Ernest  Clark^^  recently  called  the 
attention  of  the  Royal  Society  of  Medi- 

'^  Proceedings  Royal  Society  of  Medicine^  London,  Vol.  VI, 
Part  1,  pp.  315-319. 


INTESTINAL  STASIS  55 

Cine  in  London  to  the  possibility  of 
preventing  senile  changes  in  the  crystal- 
line lens  by  prompt  treatment  of  intesti- 
nal stasis  with  hquid  petrolatum.  His 
report  is  too  long  to  reproduce  entire, 
but  is  valuable  to  every  student  of  in- 
testinal stasis,  as  well  as  to  those  inter- 
ested in  ophthalmology. 

The  following  two  cases  are  examples 
of  those  cited: 

"Two  females,  one  aged  153^  and  the 
other  44,  had  the  same  accommoda- 
tive power,  viz.,  7D.  In  the  girl,  this  is 
about  4D  worse  than  normal;  and  in  the 
woman,  2D  better  than  normal.  The 
girl  was  too  young  to  show  any  outward 
sign  of  ageing,  but  she  had  a  most  un- 
healthy appearance  and  confessed  to 
habitual  constipation,  and  asserted  that 
the  bowels  were  often  open  only  twice 
a  week.  On  the  other  hand,  the  woman, 
aged  44,  looked  ten  years  younger  and 
had  always  paid  the  most  scrupulous 
attention  to  the  bowels,  and,  for  some 
time  past,  had  taken  a  daily  small  dose 
of  hquid  petrolatum."  Clark's  cases 
are  so  interesting  and  important  that  the 


56  TREATMENT  OF 

temptation  to  quote  at  length  is  great, 
but  the  following  must  suffice.  He  says: 
"It  bears  out,  incidentally,  Hertz's^ 
statement  that  a  daily  evacuation  of  the 
bowels  is  no  proof  of  the  absence  of 
intestinal  stasis.  A  man,  aged  48,  with 
an  accommodation  power  below  the 
normal,  ^^  who  had  no  suspicion  that  he 
was  suffering  from  constipation,  had 
appendicitis .  Sir  W.  Arbuthnot  Lane  oper- 
ated and  found  a  very  bad  state,  pointing 
to  many  years  of  habitual  stasis.  On  his 
recovery,  he  was  made  to  attend  most 
carefully  to  the  bowels,  and  especially  to 
take  lubricants  such  as  hquid  petrolatum. 
The  result  is  that  now,  after  some  years, 
his  accommodative  power  is  three  years 
above  the  average,  and  he  looks  and  is  a 
much  younger  man  than  his  years.  This 
case  also  shows  that  by  treatment  we 
can  give  back  a  patient  some  of  his  lost 
youth  by  arresting  the  senile  process  in 
the  lens  and  often  in  other  parts  of  the 
body. 

^*  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  p.  164. 

^  Proceedings  Royal  Society  of  Medicine,  London,  Vol.  VI, 
Part  1,  pp.  318,  319. 


INTESTINAL  STASIS  57 


€t 


I  think  I  have  said  enough  to  prove 
that  premature  hardening  of  the  lens  is 
a  very  constant  sequela  of  intestinal 
stasis  .  .  .  and  that  removal  of  the  in- 
testinal stasis  tends  to  an  arrest  of  the 
sclerosing  process.  ...  I  need  hardly 
add  that  I  have  an  enormous  faith  in 
Uquid  petrolatum  as  a  lubricant  in  curing 
stasis." 

George  Rowell^^  emphasized  his  dis- 
cussion by  clinical  cases.  He  said:  "In 
a  case  that  I  saw  recently,  a  young  lady 
who  had  marked  symptoms  of  chronic 
intestinal  stasis,  together  with  pain  over 
the  appendix,  was  treated  by  hquid  petro- 
latum for  six  months,  with  the  result  that 
the  whole  of  the  marked  objective  symp- 
toms were  cured  but  the  pain  remained. 
An  operation  was  undertaken  for  the 
pain,  and  an  appendix  tightly  held  up 
and  sharply  kinked  was  found  and  re- 
moved." Further,  "I  know  of  many 
cases  (of  pyorrhoea)  in  which  the  cure 
has  been  aided  by  Uquid  petrolatum 
internally.    Two  of  my  dental  friends,  of 

^*  Proceedings  RoycU  Society  of  Medicine,  London,  Vol.  VI» 
P^  1.  pp.  197,  198. 


58  TREATMENT  OF 

large  experience  in  this  disease,  make 
an  almost  routine  practice  of  prescrib- 
ing liquid  petrolatum  for  these  cases, 
and  one  of  them  has  told  me  that 
he  does  not  know  whether  the  liquid 
petrolatum  or  the  local  treatment  has  the 
largest  share  in  effecting  a  rapid  cure." 

RowELL®^  said  further:  "In  1901,  Eric 
Pritchard  came  to  the  conclusion  that 
disease  in  infants,  and  much  in  after  life, 
is  largely  due  to  overfeeding  during  the 
first  year.  This,  he  held,  causes  over- 
development in  the  length  of  the  bowel, 
such  an  overgrowth  often  extending  to 
many  feet  for  which  there  is  no  adequate 
room,  and,  therefore,  peristalsis  is  im- 
peded and  delay  in  the  passage  of  the 
contents  of  the  intestine  results.  For 
the  prevention  and  treatment  of  this 
condition,  he  has  given  Hquid  petrolatum 
very  largely,  and,  agreeing  with  Lane,^^  is 
convinced  that  the  constant  exhibition  of 
liquid  petrolatum  has  a  marked  effect  in 
both  the  prevention  and  the  cure  of 
tuberculosis." 

"  The  Practitioner,  1913,  XC,  p.  294. 

^Proc.  Roy.  Soc.  Med.,  Vol.  VI,  Part  1,  p.  114. 


INTESTINAL  STASIS  59 

R.  Murray  Leslie^^  says:  "  The  action 
of  liquid  ^petrolatum  is  twofold^  lubricant 
and  protective,  and  both  of  these  actions 
are  of  immense  value  in  intestinal  stasis. 
.  .  .  The  value  of  liquid  petrolatum  in 
facilitating  the  passage  of  intestinal  con- 
tents in  adults  can  be  readily  gauged  by 
watching  with  the  X-Ray  screen  the  rate 
of  passage  of  a  bismuth  meal  in  a  patient 
with  intestinal  stasis,  who  has  been  taking 
liquid  petrolatum  right  up  to  the  date  of 
examination.  In  such  a  case  the  bismuth 
may  be  observed  actually  coursing  along 
the  bowel  coils,  including  the  segments  of 
the  large  intestine;  while  in  a  similar 
case  where  no  liquid  petrolatum  has  been 
administered  the  passage  is  slow,  irreg- 
ular and  spasmodic.  .  .  .  The  effect  of 
full  doses  of  liquid  petrolatum  may 
shorten  the  time  taken  by  the  passage  of 
the  gastro-intestinal  contents  from  the 
stomach  to  the  rectum  by  as  much  as 
one-half." 

Alfred  C.  Jordan,^**  Medical  Radiog- 
rapher, of  Guy's  Hospital,  London,  says: 

^5  American  Practitioner,  1913,  Aug.,  p.  419. 
'0  The  Practitioner,  1913,  Feb.,  pp.  441-454. 


60  TREATMENT  OF 

*'The  most  universal  remedy,  short  of 
operation  (for  intestinal  stasis)  is  to  sup- 
port the  lower  part  of  the  abdomen  by 
a  suitable  shield  or  belt,  and  administer 
pure  Uquid  petrolatum.  .  .  .  The  action 
of  the  Hquid  petrolatum  is  simple;  it 
enters  the  caecum  mixed  with  the  ileal 
contents,  and  keeps  the  contents  of  the 
large  bowel  soft.  Moreover,  it  accelerates 
the  passage  of  the  faeces  through  the  large 
intestine,  which  consequently  does  not 
become  overloaded.  Far  less  bacterial 
action  goes  on,  and  the  faeces  are  found 
to  contain  far  fewer  microbes.  The 
whole  of  the  ingested  Uquid  petrolatum 
can  be  recovered  from  the  stools,  so  that 
there  are  no  absorption  of  Hquid  petro- 
latum and  no  possibility  of  a  toxic  action 
from  its  use — even  in  large  amounts. 
I  am  frequently  reminded  of  the  genuine 
eJEcacy  of  Hquid  petrolatum  in  reHeving 
intestinal  stasis,  for,  in  patients  who  are 
taking  it — or  who  have  taken  it  within 
a  fortnight  or  so  of  the  X-ray  examina- 
tion— I  have  the  greatest  diflSculty  in 
obtaining  X-ray  evidence  of  the  stasis, 
although     it     is     undoubtedly     present 


INTESTINAL  STASIS  61 

when    the    patient    is    not    under   this 
treatment." 

J.  H.  Kellogg'^  writes:  "Liquid  petro- 
latum will  not  remedy  every  defect  in 
the  defecating  process,  and  hence  will 
not  cure  every  case  of  constipation,  but 
it  comes  nearer  being  a  panacea  than  any 
remedy  which  has  heretofore  been  found, 
and  does  meet  a  surprisingly  large  number 
of  indications.  After  a  careful  study  of 
its  effects  in  several  thousand  cases,  the 
writer  feels  justified  in  saying,  with  much 
confidence,  that  hquid  petrolatum  may 
be  rehed  upon  to  accomphsh  the  following 
results  in  the  treatment  of  chronic  con- 
stipation: 

"1.  It  lubricates  the  ahmentary  canal 
throughout  its  whole  length.  In  a  large 
number  of  cases  of  constipation  there  is 
an  excessive  absorption  of  water  from 
the  colon,  leaving  the  faeces  dry,  or  pasty 
and  adhesive.  .  .  .  The  use  of  half  an 
ounce  or  an  ounce  of  hquid  petrolatum 
at  bed-time  and  haK  as  much  half  an  hour 
before  each  meal  will  in  two  or  three 
days  change  the  condition  completely. 

"  New  York  Medical  Journal,  1914,  Sept.  12,  p.  504  et  seq. 


62  TREATMENT  OF 

"2.  This  mechanical  lubricating  action 
of  Uquid  petrolatum  is  highly  important 
in  overcoming  kinks  due  to  redundancy 
or  to  Jackson's  membrane,  adhesions 
resulting  from  colitis  or  other  causes. 

"3.  The  concentrated  diet  of  our  mod- 
ern civihzed  life  contains  so  little  indi- 
gestible material  that  the  residue  forms 
a  pasty  mass  which  tends  to  adhere  to 
the  intestinal  wall.  .  . .  Fats  . . .  are  more 
or  less  laxative  if  taken  in  suflScient 
amounts  .  .  .  but  both  animal  and  vege- 
table fats  are  digestible  and  absorbable, 
hence  (in  usable  amounts)  .  . .  are  not  ef- 
fective in  changing  the  character  of  the 
stool.  . . .  Liquid  petrolatum  is  free  from 
these  objections,  since  it  is  wholly  non- 
absorbable, and  a  comparatively  small 
amount  serves  the  purpose  required  be- 
cause it  all  remains  in  the  intestine. 

"4.  Liquid  petrolatum  is  useful  in  all 
forms  of  intestinal  stasis,  no  matter  what 
the  cause,  by  preventing  the  abnormal 
drying  out  of  the  food  residues  which  is 
the  necessary  result  of  too  long  retention 
in  contact  with  absorbing  surfaces. 
'  "5.  Liquid  petrolatum  .  .  .  stimulates 


INTESTINAL  STASIS  63 

activity  of  the  small  intestine,  .  .  .  great- 
ly accelerates  the  passage  of  material 
through  the  small  as  well  as  the  large 
intestine.  •  .  .  Stagnation  in  the  small 
intestine  is  of  far  greater  importance 
than  stasis  in  the  colon,  for  the  reason 
that  both  putrefaction  and  absorption 
are  (in  it)  much  more  active  than  in  the 
large  intestine.  Even  in  cases  .  .  •  due 
to  .  .  .  Lane's  kink  .  .  .  great  relief  may 
usually  be  obtained  by  the  regular  use 
of  liquid  petrolatum. 

•  "6.  One  of  the  very  interesting  fea- 
tures of  the  many-sided  useful  activities 
of  liquid  petrolatum  is  its  behavior 
toward  intestinal  toxins.  These  toxins 
consist,  not  only  of  bile  acids  and  alkaline 
wastes  of  various  sorts  excreted  by  the 
intestinal  mucous  membrane,  but,  in  addi- 
tion, of  a  great  variety  of  ptomaines  and 
toxins  produced  through  bacterial  action, 
especially  in  the  colon  and  also  in  the 
small  intestine  in  cases  of  incompetency 
of  the  ileo-csecal  valve.  Liquid  petro- 
latum is  a  highly  active  solvent  and  read- 
ily dissolves  these  waste  and  poisonous 
substances,    many   of    which   are   more 


64  TREATMENT  OF 

soluble  in  liquid  petrolatum  than  in 
water.  The  result  is  that  the  liquid 
petrolatum,  itself  not  absorbable,  takes 
up  a  very  considerable  portion  of  the 
toxins  found  present  in  the  intestinal 
tract  and  thus  prevents  their  absorption. 
When  Hquid  petrolatum  is  used,  it  may 
always  be  seen  in  the  stools,  showing  a 
brownish  or  blackish  color,  due  to  the 
substances  which  it  holds  in  solution. 
In  a  laboratory  test  made  by  a  com- 
petent chemist  by  request  of  the  writer, 
it  was  found  that  when  liquid  petrolatum 
was  shaken  with  a  watery  solution  of 
indol,  more  than  half  the  indol  was 
quickly  taken  up  by  the  hquid  petro- 
latum. The  use  of  hquid  petrolatum 
thus  affords  an  effective  means  of  hinder- 
ing the  absorption  of  intestinal  toxins 
and  conveying  them  out  of  the  body. 

"7.  Liquid  petrolatum  is  useful  .  .  • 
in  protecting  the  mucous  membrane  when 
...  irritated,  as  in  .  .  .  chronic  colitis. 
.  .  .  The  value  of  hquid  petrolatum  as  a 
dressing  for  wounds  is  well  known.  .  .  . 
Liquid  petrolatum  acts  in  an  equally  favor- 
able way  upon  irritated  mucous  surfaces. 


INTESTINAL  STASIS  65 

"8.  Liquid  petrolatum  is  a  useful 
protective  .  .  .  hindering  the  absorption 
of  poisons  by  mucous  surfaces  which  have 
been  deprived  of  their  epithehum.  The 
normal  epithehal  covering  of  the  intes- 
tines has  remarkable  filtering  powers,  by 
which  toxins,  especially  colloid  poisons, 
are  excluded.  This  filtering  power  is  lost 
when  the  surface  is  denuded.  .  .  •  Liquid 
petrolatum  renders  great  service  in 
such  cases  by  hindering  the  absorp- 
tion of  these  poisons  which  occurs 
with  great  readiness  thi^ough  abraded 
surfaces. 

"9.  Li  cases  of  colitis  liquid  petro- 
latum not  only  protects  the  irritated  sur- 
faces, but  also  through  its  lubricating 
effect  and  through  softening  the  intestinal 
contents  aids  greatly  in  overcoming  the 
spastic  condition  of  the  intestine,  which 
in  many  cases  of  chronic  constipation  is 
so  formidable  an  obstacle  to  recovery. 
Laxatives  of  all  sorts  increase  the  spas- 
ticity of  the  intestine''^  and  so  aggravate 
the  constipation  which  they  are  given  to 

'2C/,  supra.  §  \^II.,  p.  53  (Brit.  Jour.  Surg.,  1915,  April, 
p.  581),  (Lancet,  London,  1915,  July  3,  pp.  18,  19,  Aug. 
21,  pp.  374-375). 


66  TREATMENT  OF 

relieve.  This  is  one  reason  why  many- 
are  more  constipated  after  taking  a  laxa- 
tive than  before.  Temporary  relief  is 
obtained  by  the  production  of  watery 
stools  which  are  able  to  pass  through  the 
contracted  bowel,  but  as  soon  as  the  first 
effects  of  the  laxative  pass  off,  constipa- 
tion becomes  worse  than  before,  since  the 
spasm  is  greater.  Liquid  petrolatum  lu- 
bricates and  protects  the  sensitive  surface 
of  the  spastic  bowel,  and  at  the  same 
time  softens  the  intestinal  contents  so  as 
to  permit  passage  through  the  bowel 
without  mechanical  irritation.  Cases  of 
colitis  are  greatly  benefited  by  the  regular 
use  of  liquid  petrolatum. 

"10.  Incompetency  of  the  ileo-csecal 
valve  is  a  very  active  and  frequent  cause 
of  serious  disease,  ...  a  common  and 
effective  cause  of  iliac  stasis.  The  ex- 
perience in  treating  several  hundreds  of 
cases  has  shown  that  aside  from  the  regu- 
lation of  diet  the  regular  use  of  liquid 
petrolatum  is  the  most  effective  means 
of  combating  this  condition.  Medicinal 
laxatives  cannot  be  used  in  these  cases 
for  the  reason  that  they  stimulate  the  an- 


INTESTINAL  STASIS  67 

tiperistalsis  by  which  the  reflux  from  the 
colon  into  the  small  intestine  is  increased. 
James  T.  Case  has  shown  by  X-ray  ex- 
amination that  liquid  petrolatum  in- 
creases the  motility  of  the  small  intestine 
while  it  does  not  increase  antiperistalsis. 

"11.  In  cases  in  which  the  iliac  stasis 
is  due  to  spasm  of  the  ileo-csecal  valve, 
induced  by  chronic  appendicitis,  ovarian 
irritation  or  inflammation,  colitis,  or  pos- 
sibly painful  rectal  disease  through  reflex 
irritation,  liquid  petrolatum  proves  itself 
to  be  an  invaluable  remedy,  since  it  has 
the  property  of  increasing  the  peristaltic 
activity  of  the  small  intestine  to  such  a 
degree  as  to  enable  it  to  overcome  the 
spasm  of  the  ileo-C8ecal  valve  without 
producing  irritation  which  would  inevi- 
tably increase  the  spasm  of  the  sphincter, 
as  do  drug  laxatives.  The  pecuHar  prop- 
erty of  liquid  petrolatum  which  enables 
it  to  stimulate  and  facilitate  intestinal 
motility  without  producing  irritation,  is 
invaluable.  The  regular  use  of  liquid 
petrolatum  very  generally  relieves  hemor- 
rhoids and  fissure  even  when  of  some  years' 
standing.     These  morbid  conditions  are 


68  TREATMENT  OF 

usually  the  result  of  constipation,  and  are 
maintained  and  aggravated  by  straining 
at  stool.  By  the  habitual  use  of  hquid 
petrolatum  the  stools  are  made  soft, 
straining  is  avoided,  the  sensitive  surface 
is  protected,  the  intestinal  contents  are 
rendered  less  irritating  and  infectious,  and 
thus  the  tissues  are  given  an  opportunity 
to  heal  and  return  to  a  normal  condition. 

"12.  Since  adopting  the  use  of  Kquid 
petrolatum  the  author  has  found  that  the 
number  of  cases  in  which  operation  for 
hemorrhoids  is  required  is  greatly  re- 
duced. Patients  who  have  contemplated 
submitting  to  operation  for  removal  of 
hemorrhoids  of  many  years'  standing, 
often  within  a  week  after  beginning  the 
use  of  hquid  petrolatum  have  found  them- 
selves so  completely  reKeved  that  an 
operation  was  no  longer  considered. 

''13.  Liquid  petrolatum  is  capable  of 
rendering  invaluable  service,  in  cases 
of  intestinal  intoxication,  by  increasing 
the  number  of  daily  stools.  The  length 
of  time  that  foodstuffs  remain  in  the 
intestine  is  reduced  from  several  days  to 
a  few  hours.    This  greatly  lessens  the 


INTESTINAL  STASIS  69 

opportunity  for  development  of  putre- 
factive processes  and  the  absorption  of 
putrefaction  products.  By  the  use  of 
Kquid  petrolatum  in  connection  with  an 
antitoxic  diet  and  antitoxic  ferments  such 
as  the  cultures  of  the  bacillus  BulgaricuSy 
bacillus  bifidus,  and  bacillus  glycobacter, 
it  becomes  a  comparatively  easy  matter 
to  change  the  intestinal  flora — a  task  dif- 
ficult without  this  aid  and  very  often  im- 
possible. Any  one  who  has  made  a 
serious  effort  to  change  the  intestinal 
flora,  checking  up  his  dietetic  and  other 
prescriptions  by  frequent  bacteriological 
examinations  of  the  faeces  and  chemical 
examination  of  the  urine,  knows  how 
diflicult  a  task  this  is.  It  is  absolutely 
necessary  that  constipation  should  be 
overcome.  Laxative  drugs  are  harmful, 
as  pointed  out  by  Combe  long  ago,  and 
hence  cannot  be  used  to  advantage,  but 
liquid  petrolatum  is  harmless;  and,  by  its 
systematic  use  in  combination  with  other 
suitable  measures,  success  may  be  ob- 
tained in  all  cases  in  which  conditions 
requiring  surgical  interference  do  not 
exist.     Indeed  .  .  •  experience  has  dem- 


70  TREATMENT  OF 

onstrated  that  by  the  systematic  use  of 
liquid  petrolatum  combined  with  a  laxa- 
tive and  antitoxic  dietary,  a  very  large 
proportion,  probably  by  far  the  largest 
proportion,  of  the  cases  now  subjected  to 
short  circuiting  and  other  operations 
might  escape  surgical  interference  alto- 
gether; certainly  a  thing  greatly  to  be 
desired. 

''Liquid  petrolatum  possesses  so  many 
advantages  that  it  will  be  given  prece- 
dence over  all  laxatives  under  nearly 
all  circumstances,  when  its  merits  are 
appreciated." 

Bainbridge^^  says:  "Liquid  petrola- 
tum is  the  agent  which  by  common  con- 
sent is  pronounced  the  most  satisfactory 
in  the  treatment  of  chronic  intestinal 
stasis.  .  .  .  Liquid  petrolatum  commonly 
found  in  the  market  is  not  sufficientlv 
refined  to  be  entirely  free  from  irritating 
ingredients  or  to  be  agreeable  to  the  taste. 
Some  of  the  products  are  too  thin,  and 
consequently  give  rise  to  'dribbhng,'  which 
is  not  only  extremely  disagreeable,  but 

^3  Woman's  Medical  Journal,  1914,  Jan.,  p.  10. 


INTESTINAL  STASIS  71 

defeats  the  purpose  for  which  the  oil  is 
given." 

R.  Murray  Leslie ^^  says:  "The  nu- 
merous aperient  remedies^  the  indiscrimi- 
nate use  of  which  is  directly  opposed  to 
the  modern  view  of  rational  therapeutics, 
have  now  been  largely  superseded  by  the 
use  of  lubricants,  particularly  liquid  petro- 
latum, which  in  the  writer's  opinion  is  by 
far  the  most  valuable  internal  remedy  in 
the  treatment  of  intestinal  stasis."  .  .  . 

"As  one  of  the  first  to  systematically 
administer  liquid  petrolatum  in  intestinal 
stasis,  the  writer  can  speak  with  some 
authority  in  regard  to  its  value.  As  the 
result  of  his  experience  he  has  no  hesita- 
tion in  stating  that,  in  the  large  majority 
of  cases  of  early  intestinal  stasis,  the 
judicious  use  of  liquid  petrolatum  (in  as- 
sociation with  diet  modifications,  hygienic 
measures,  and,  in  some  cases,  with  prop- 
erly constructed  supporting  belts)  is  usu- 
ally quite  efficacious  in  affording  per- 
manent relief." 

'4  American  Practitioner,  New  York,  1913,  Aug.,  p.  418. 


72  TREATMENT  OF 

IX. 

Constipation  in  Infants. 

Elie  Metchnikoff  75  says:  "Infants 
are  frequently  seriously  ill  as  the  result 
of  constipation.  .  .  .  The  illness  may 
lead  to  death,  but  is  generally  cured  by 
simple  purging." 

Eric  Pritchard/^  of  the  Queen's  Hos- 
pital for  Children,  London,  says:  "At  one 
time  it  was  my  invariable  practice  to 
treat  cases  of  constipation  in  infants  with 
additional  feedings  of  cream.  .  .  .  Unless 
the  evidence  from  collateral  sources 
is  clear  that  the  percentage  of  fat  is 
below  the  nutritive  requirements,  this 
line  of  treatment  has  httle  to  commend 
it.  This  difficulty  can  be  avoided  by 
substituting  hquid  petrolatum  for  fat. 
Liquid  petrolatum  never  gives  rise  to 
nutritional  or  to  digestive  disturbances; 
it  is  an  absolutely  inert  lubricant,  which 
passes  out  of  the  bowel  in  exactly  the 
same  condition  as  it  enters  the  mouth; 

^■5  £lie  Metchnikoff,  The  Prolongation  of  Life,  Eng.  trans., 
p.  67;   DU  Pasquier,  Gazette  des  Hopitaux,  1904,  p.  715. 
''^  The  Practitioner,  London,  1910,  May,  p.  594. 


INTESTINAL  STASIS  7S 

moreover,  every  trace  of  it  can  be  re- 
covered from  the  faeces.  If  given  in 
sufficient  quantities  it  will  soften  the 
hardest  scybala,  and  substitute  soft  plas- 
tic stools  which  pass  with  ease  through 
the  sigmoid  and  rectum." 

P.  G.  Easton"  says:  "The  chronic 
constipation  of  children  and  infants  often 
yields  most  easily  to  liquid  petrolatum  in 
small  doses  given  regularly  three  times  a 
day  at  first,  and  later  reducing  the  dose 
to  once  a  day,  preferably  at  bedtime. 
Thus  a  breast-fed  baby  of  six  months  was 
practically  cured  of  constipation  by  ad- 
ministering 15  drops  of  hquid  petrolatum 
added  to  a  teaspoonful  of  water  and 
given  before  its  bottle  three  times  a  day." 

Eric  Pritchard,^^  of  London,  England, 
says:  "The  treatment  of  constipation 
resolves  itself  into  the  restoration  and 
regulation  of  the  secretory  functions.  .  .  . 
In  all  cases  of  constipation  the  diet  must 
be  thoroughly  supervised.  .  .  .  If  no  ob- 

'^  Journal  Royal  Army  Medical  Corps,  London,  1914,  22, 
p.  443. 

''^  The  Physiological  Feeding  of  Infants,  by  Eric  Pritchard, 
Srd  edition,  1909,  pp.  260-267,  434-435. 


74  TREATMENT  OF 

vious  error  be  discovered  in  the  dietary, 
a  careful  examination  of  the  stools  may 
throw  hght  on  the  cause  and  suggest 
lines  of  treatment."  He  distinguishes  in 
constipation  three  classes  of  stools: 

"  1.  Large,  Pasty  Stools,  Light-Colored, 
of  Foul  Odor  and  of  Greasy  Consistence. 
.  .  .  The  indications  for  treatment  are 
to  restore  the  activity  of  the  hver  and 
pancreas  and  to  increase  and  regulate 
the  peristaltic  functions. 

"2.  Small,  Elongated  Stools,  very  Hard 
and  Brittle,  Light-Colored,  or  even  White. 
...  In  cases  of  this  kind  an  increase  of 
the  percentage  of  fat  in  the  food  will 
often  accomplish  the  desired  end;  .  .  . 
if  an  infant  who  passes  motions  of  this 
kind  has  an  ample  allowance  of  fat  in  the 
food,  say  4  per  cent.,  if  it  is  putting  on 
weight  in  a  normal  manner,  say  six  ounces 
a  week,  and  if  there  is  no  other  indication 
for  an  increase  in  fat  except  the  consti- 
pated condition  of  the  stools,  it  may  be 
hazardous  to  run  the  risk  of  inducing  fat 
dyspepsia  by  increasing  the  amount  of 
the  constituent. 

"It  was  the  diflSculty  of  treating  this 


INTESTINAL  STASIS  75 

variety  of  constipation  on  scientific  and 
rational  lines  that  led  me  to  devise  the 
following  method,  to  which,  so  far  as  I 
know,  there  is  absolutely  no  objection: 

"There  is  no  vegetable  or  animal  oil 
that  can  reach  the  lower  bowel  and  soften 
constipated  stool,  unless  it  is  given  in 
such  excess  that  it  is  neither  digested  nor 
absorbed,  hence  there  is  danger  of  fat 
dyspepsia;  but  a  mineral  oil  such  as 
hquid  petrolatum,  in  whatever  doses  it 
is  administered,  will  always  reappear  in 
the  motions  and  soften  them  to  an  extent 
which  is  directly  proportional  to  the 
amount  given.  Liquid  petrolatum  can- 
not decompose  in  the  bowel  and  cause 
offensive  motions  like  excess  of  fat.  It 
cannot  become  absorbed  and  tax  the  re- 
sources of  the  hver;  in  fact,  it  behaves 
as  the  most  perfect  mechanical  lubricant 
of  the  bowel,  and  has,  as  far  as  I  know, 
absolutely  no  injurious  therapeutic  action. 
I  have  used  it  now  consistently  for  two 
years,  both  in  my  private  practice  and 
at  my  infant  consultations  in  Welbeck 
Street,  and  I  have  never  had  any  reason 
to  find  fault  with  it.     I  find  it  an  excellent 


76  TREATMENT  OF 

vehicle  for  a  large  number  of  drugs,  but 
more  especially  for  pancreatic  extract. 
The  form  in  which  I  give  the  hquid  petro- 
latum is  an  emulsion,  of  which  I  give  the 
formula. 

''This  emulsion  is  most  useful  as  an 
intestinal  lubricant  in  cases  of  constipa- 
tion or  ulceration  of  the  bowel.  It  may 
be  prepared  as  follows : 

Pure  Liquid  Petrolatum 20  minims 

Powdered  Gum.  Acacia 10  graios 

Essential  Oil  Almond Vi6  Tninim 

Elixir  SaccKarin  (1  :  20) J^  minim 

Water  to  make 1  drachm 

"Liquid  petrolatum  emulsion  is  a  good 
vehicle  for  insoluble  drugs  such  as  sulphur 
and  the  salts  of  bismuth,  and  also  for  the 
digestive  ferments  such  as  papain  and 
pancreatin.  The  formula  I  employ  for 
pancreatin  is  as  follows: 

liquor  Pancreatis 10  minims 

Sodiimi  Bicarbonate 4  grains 

Boracic  Acid 3^  grain 

Liquid  Petrolatimi  Emulsion  to  make. . .     1  drachm 

"Adults  as  well  as  infants  find  this 
emulsion  quite  agreeable.  .  .  .  For  in- 
fants I  generally  order  one  teaspoonful 


INTESTINAL  STASIS  77 

three  times  a  day,  after  food,  but  I  always 
tell  the  mother  to  begin  with  quite  small 
doses,  say  a  quarter  of  a  teaspoonful, 
and  then  gradually  to  increase  the  dose 
till  the  full  amount  is  reached.  .  .  . 
Three  teaspoonfuls  of  the  liquid  petro- 
latum emulsion  are,  as  a  rule,  quite 
enough  to  render  constipated  stools  of  the 
kind  under  consideration  amply  soft,  but 
if  they  still  remain  hard  there  is  no  harm 
in  increasing  the  dose  up  to  six  or  seven 
teaspoonfuls  a  day. 

"3.  Small,  Marble  -  Shaped  Stools, 
sometimes  with  Pieces  of  Dried  Mucus 
Adherent  to  their  Surface,  sometimes 
with  Traces  of  Blood.  .  .  . 

"The  treatment  of  the  condition  of  the 
bowel  which  gives  rise  to  motions  of  this 
kind  will  depend  very  largely  on  the 
symptoms  which  have  preceded  the  con- 
stipation." 

Pritchard,^^  in  a  paper  on  Some  Prac- 
tical Points  in  the  Management  of  Breast 
Feeding,  adds:  "The  mechanism  of 
defecation  depends  on  a  somewhat  com- 

^3  Archives  of  Pediatrics,  1913,  March,  pp.  165-167. 


78  TREATMENT  OF 

plicated  nervous  reflex.  .  .  .  The  regu- 
larity and  efficiency  with  which  the  cen- 
ters ply  their  automatic  functions  depend 
very  largely  on  the  nature  and  character 
of  early  training.  There  is  nothing 
more  damaging  to  a  young  center  than 
overstimulation,  and  there  is  no  worse 
form  of  education  for  the  inexperienced 
centers  of  defecation  than  overstimula- 
tion with  castor  oil,  glycerin  suppositories, 
or  soap-and-water  enemata.  All  these 
violent  expedients  exhaust  the  centers  and 
leave  the  reactionary  constipation. 

''.  .  .  The  epithelial  lining  of  the  in- 
testine is  a  very  delicate  and  sensitive 
structure,  easily  damaged,  easily  torn  off, 
and  easily  stimulated.  Meconium  seems 
most  nicely  adjusted  to  preserve  and  pro- 
tect so  delicate  a  mucous  surface,  until 
such  time  as  it  is  replaced  by  the  normal 
constituents  of  an  infant's  stool.  Per- 
sonally, I  believe  that  many  a  colitis  is 
determined  in  young  infants  by  the  pre- 
mature sweeping  out  of  the  meconium. 
...  So  important  to  my  mind  is  the 
function  of  meconium  that  when  it  is 
deficient  in  quantity  or  prematurely  ex- 


DsTESTEsAL  STASIS  79 

pelled  by  accident  or  undue  interference, 
I  always  take  care  that  it  is  replaced  by 
an  efficient  substitute.  The  best  sub- 
stitute that  I  have  so  far  been  able  to 
discover  is,  without  doubt,  hquid  petro- 
latum emulsion.  Liquid  petrolatum  is  a 
good  lubricant,  and,  hke  meconium,  it  is 
not  assimilated  by  the  epithehal  cells,  and 
thus  reduced  in  bulk  as  it  descends  the 
bowel — ^that  is  to  say,  it  reaches  the 
rectum  intact. 

"It  is  physiologically  an  inert  sub- 
stance; it  is  protective,  lubricant,  and 
soothing.  In  fact,  so  satisfactory  does 
its  administration  prove  that  I  now  give 
it  in  all  cases  in  which  the  infant  suffers 
from  tormina,  entero-spasm,  or  dys- 
peristalsis.  When  prepared  according 
to  the  formula  following  I  find  infants 
take  it  well: 

Liquid  Petrolatuia 20  drops 

Benzoic  Acid '^Is2  grain 

Saccharin Vss  grain 

Oil  Cinnamon ^/le  drop 

Decoction  Irisii  Moss  to  make 1  teaspoonful 

Dose:   A  teaspoonfiil  to  a  tablespoonful,  from  three  to  six 
times  a  day." 

"I  would  here  utter  a  word  of  caution 
against  the  indiscriminate  use  of   some 


80  TREATMENT  OF 

of  the  largely  advertised  petroleum  emul- 
sions, partly  for  the  reason  that  their 
flavoring  and  method  of  manufacture  are 
not  calculated  to  benefit  infants,  but 
chiefly  because  they  may  contain  supple- 
mentary bodies,  such  as  hypophosphites, 
which  are  not  required  by  infants  and 
which  cannot  be  given  safely,  except  in 
very  small  dosage.  With  an  emulsion 
of  the  formula  here  given  the  dosage  may 
be  as  large  as  two  ounces  a  day,  divided 
into  as  many  doses  as  the  baby  receives 
feed,  or  as  small  as  one  teaspoonful  in 
the  twenty -four  hours.  *  Such  an  emul- 
sion is  an  excellent  vehicle  for  all  the 
drugs  that  are  usually  administered  to 
infants,  and  it  matters  little  whether  such 
drugs  be  soluble  or  insoluble  provided 
the  emulsion  itself  is  well  shaken  before 
it  is  poured  out  of  the  bottle." 

X. 

Liquid  Petrolatum  During  Pregnancy 
AND  Lactation. 
Elie  Metchnikoff,^^  ten    years  ago, 
showed  that  "Women  in  pregnancy  and 

8°  i%e  Prolongatio  .  of  Life.    Part  II,  Chap.  Ill,  Eng.  trans., 
pp.  68,  71. 


INTESTINAL  STASIS  81 

childbirth  frequently  suffer  much  as  the 
result  of  retention  of  fsecal  matter,"  but 
the  necessity  of  caring  for  the  mother's 
bowels  during  pregnancy  and  while  she  is 
nursing  her  infant  is  so  well  recognized 
today  that  it  does  not  need  emphasizing. 
However,  it  is  often  difficult  to  settle  upon 
the  means  by  which  the  desired  maternal 
condition  may  be  brought  about  and  at  the 
same  time  leave  the  foetus  or  the  nursing 
child  undisturbed  thereby.  Cathartics  and 
laxatives  may  extend  their  influence  by 
means  of  the  placental  circulation  or  the 
milk  so  that  a  more  or  less  serious  medica- 
tion be  produced  for  the  child  in  utero  or 
at  the  breast.  The  extent  of  such  in- 
fantile disturbance  and  distress  depends 
upon  the  nature  and  amount  of  the  drug 
administered  and  the  general  physical 
condition  of  the  mother  the  child,  or  both. 
Sometimes  such  indirect  treatment  of 
the  infant  may  be  desirable,  but  unless 
it  is  indicated  by  some  special  condition 
of  the  child,  it  is  best  to  avoid  it,  and, 
therefore,  in  cases  in  which  the  bowels  of 
the  parturient  or  the  nursing  mother 
demand  regulating  and  those  of  her  child 


82  TREATMENT  OF 

do  not,  a  remedy  that  can  influence  the 
mother  and  not  the  child  is  desirable. 

Liquid  petrolatum  meets  the  demand. 
To  correct  the  constipation  of  pregnancy, 
to  avoid  the  hemorrhoidal  condition  which 
so  often  attends  it,  to  prevent  or  relieve 
postpartum  intestinal  stasis,  and  for  all 
other  conditions  for  which  it  is  indicated, 
a  pure  liquid  petrolatum  may  be  used  by 
the  mother  in  any  necessary  amount, 
without  fear  of  any  influence  on  her  child, 
since  the  oil  does  not  enter  the  maternal 
circulation,  but  exercises  its  influence  in  a 
mechanical  way  in  the  gastro-intestinal 
tract  alone. 

XI. 

Liquid  Petrolatum  for  the  Insane. 

R.  Murray  Leslie  ^^  writes  that  he 
*'has  had  excellent  therapeutic  results 
from  the  administration  of  Hquid  petro- 
latum in  mucous  colitis,"  and  says  that 
"there  is  a  great  field  for  the  employ- 
ment of  liquid  petrolatum  in  asylums  for 
the  insane,  as  the  inmates  are  par- 
ticularly prone  to  mucous  colitis." 

^^  American  Practitioner,  1913,  Aug.,  pp.  420-421. 


INTESTINAL  STASIS  83 

XII. 

Surgical  Use  of  Liquid  Petrolatum. 

What  has  been  said  up  to  this  point  is 
primarily  non-surgical.  There  are,  never- 
theless, uses  for  liquid  petrolatum  in  sur- 
gery directly  or  indirectly  connected  with 
enterostasis. 

Liquid  petrolatum  has  been  of  use  intra- 
abdominally  to  prevent  adhesions,  having 
been  used  even  when  all  raw  surfaces  were 
covered  with  peritoneum.  For  the  sur- 
geon, however,  liquid  petrolatum  has 
come  to  be  of  value  from  the  point  of 
view  of  intestinal  stasis  alone.  It  is  now 
used  as  follows: 

(A)  By  mouth — as  a  prophylactic,  begin- 
ning some  time  before  operating. 

Bainbridge^^  says:     "Lane  describes: 
''1.  An  abnormal  fixation  of  the  pylo- 
rus" .  .  .  which  .  . 

"2.  may  result  in  the  production  of  a 
kink,  .  .  .  sufficient  to  interfere  with  the 
normal  functioning  of  the  stomach  and 

82  New  York  Medical  Record,  1913,  Sept.  27,  pp.  554-556. 


84  TREATMENT  OF 

the  duodenum,  consequently  areas  of  en- 
gorgement of  the  mucous  membrane  arise 
in  the  front  part  of  the  duodenum  or  in 
the  lesser  curvature  of  the  stomach. 
While  the  stress  sustained  at  the  point  of 
engorgement  is  a  primary  factor,  the  lower 
resistance  power  to  the  entry  of  micro- 
organisms, due  to  autointoxication,  takes 
a  large  share  in  the  production  of  the  in- 
flammatory changes  in  the  mucous  mem- 
brane. 

"10.  Associated  with  intestinal  stasis, 
there  is  a  considerable  ascent  in  the  level 
of  deleterious  organisms  in  the  small  in- 
testines with  occasional  infections  of  the 
biliary  and  pancreatic  ducts,  producing 
gallstones,  pancreatitis,  and,  later,  cancer 
of  these  several  structures." 

Therefore  a  course  of  liquid  petrolatum 
before  operation  prevents  compHcations 
which  otherwise  might  arise. 

(B)  Before  operating  to  aid  in  determin- 
ing whether  the  case  is  surgical  or  not. 

Lane  ^^  says:  "We  find  some  diflficulty 
in  drawing  the  line  between  the  cases  in 

8^  British  Medical  Journal^  1912,  May  4,  p.  989. 


INTESTINAL  STASIS  85 

which  the  stasis  can  be  met  efficiently 
by  the  use  of  hquid  petrolatum  and  those 
in  which  an  alteration  in  the  drainage 
scheme  is  advisable.  In  all  doubtful 
cases  we  give  liquid  petrolatum  a  thor- 
ough trial  before  adopting  operative 
procedures." 

Hayes ^^  says:  "Surgery  ...  is  in- 
dicated in  the  marked  cases  (of  intestinal 
stasis)  failing  to  respond  to  persistent, 
competent  medical  treatment." 

Coffey ^^  says:  "Gastric  or  intestinal 
stasis  not  relieved  by  medical  and  dietary 
measures  constitutes  the  only  excuse  for 
surgery  in  this  class  of  cases." 

A  more  or  less  steady  and  prolonged 
use  of  liquid  petrolatum  will  make  clear 
in  a  given  doubtful  case  of  intestinal 
stasis  whether  resort  should  be  made 
to  surgery. 

(C)  Intra-abdominally  toward  the  end 
of  the  operation  for  the  prevention  of  post- 
operative stasis,  etc. 

84  New  York  Medical  Record,  1914,  Feb.  28,  p.  410. 

^  Surgery,  Gynecology,  and  Obstetrics,  1912,  Oct.,  p.  248. 


86  TREATMENT  OF 

Waters  F.  Burrows  ^^  says  that  plac- 
ing an  abdominal  case  early  after  opera- 
tion in  the  sitting  posture  avoids  many 
complications.  "Intestinal  functioning  is 
likewise  bettered  .  .  .  yet  frequently  in- 
testinal disturbance  is  shown.  .  .  .  The 
pain  disturbance  and  actual  dangers  re- 
sulting from  post-operative  bowel  stasis 
make  evident  the  importance  of  prophy- 
laxis. .  .  .  Abrasion  of  the  peritoneal  sur- 
face of  the  gut  is  a  most  common  and 
frequently  unavoidable  cause  of  post- 
operative stasis.  The  method  of  over- 
coming the  effects  of  this  traumatism  by 
means  of  liquid  petrolatum  introduced 
within  the  abdominal  cavity  at  operation 
has  proved  effectual  and  safe."  ..."  In 
most  simple  abdominal  operations  its  use 
is  not  required  since  prophylactic  care 
will  limit  post-operative  distress,  but  in 
all  others  the  oil  is  of  the  greatest  value 
when  employed  upon  abdominal  pads 
during  operation  or  sponged  gently  upon 
intestinal  coils  previous  to  closure  of  the 
incision,  excluding  only  areas  where  ad- 
hesions are  desired  and  having  care  that 

88  New  York  Medical  Record,  1913,  Nov.  1,  pp.  795-798 


INTESTINAL  STASIS  87 

all  plastic  procedures  and  intestinal 
anastomoses  are  completed  before  the  oil 
is  introduced.  In  cases  presenting  ex- 
tensive adhesions  or  widespread  perito- 
nitis, large  amounts  of  liquid  petrolatum 
(up  to  6  or  8  ounces)  are  required  to  pre- 
vent recurrence  or  formation  of  adhesions, 
to  limit  the  absorption  of  toxins  from  the 
peritoneal  cavity,  to  assist  nature  in 
combating  infection,  and  as  a  prophylac- 
tic against  intestinal  stagnation,  obstruc- 
tion, spasm,  and  final  paresis.  In  the 
case  of  more  than  moderate  severitv, 
intestinal  spasm  and  stasis,  together  with 
abdominal  pain,  are  largely  ehminated 
and  convalescence  is  more  comfortable 
and  safe,  while  the  indi^'idual  in  dire 
straits  at  the  time  of  surgical  interven- 
tion has,  post-operatively,  manifold  better 
chances  of  recovery." 

Burrows  condemns  the  use  of  iodine, 
mercuric  chloride  solution,  carboHc  acid, 
alcohol,  etc.,  applied  to  the  peritoneum, 
also  olive  oil  and  commercial  hquid 
petrolatum,  but  says:  "Liquid  petro- 
latum (of  the  naphthene  series)  causes 
none   of   the   changes   occiu-ring   in   the 


88  TREATMENT  OF 

process  of  adhesion  formation.  .  .  .  The 
oil  has  no  appreciable  chemical  action 
upon  the  tissues  nor  deleterious  effect 
upon  the  animal  and  is  slowly  absorbed. 
...  It  prevents  to  a  great  extent  the  for- 
mation or  recurrence  of  adhesions  .  .  .  fills 
the  lymphatic  channels,  thus  limiting 
septic  absorption,  and  .  .  .  prevents  ex- 
tension of  destructive  processes.  It  is 
used  to  advantage  intra-abdominally  in 
place  of  salt  solution,  upon  abdominal 
pads,  and  to  protect  and  lubricate  the 
abdominal  contents,  thereby  eliminating 
or  minimizing  post-operative  intestinal 
stasis,  vomiting,  and  abdominal  pain." 

Later,  Burrows  ^^  emphasizes  the  post- 
operative intra-abdominal  use  of  liquid 
petrolatum  in  his  paper  before  the  Hud- 
son County  (N.  J.)  Medical  Society.  He 
says:  "After  correction  of  apparent  ab- 
normalities, which  in  several  instances 
has  consisted  solely  in  breaking  down 
adhesions  and  eliminating  kinks,  the 
writer,  in  selected  cases,  pours  6  to  10 
ounces  of  purified  liquid  petrolatum,  pref- 

87  New  York  Medical  Record,  1914,  Apr.  11,  p.  656. 


INTESTEsTAL  STASIS  89 

erably  of  high  specific  gravity,  into  the 
abdominal  cavity.  This  oil  prevents 
the  recurrence  of  adhesions,  lubricates  the 
intestinal  coils,  straightens  out  angula- 
tions and  kinks,  floats  the  gas-filled  loops 
of  gut  out  of  the  pelvic  cavity,  exerts  an 
intra-abdominal  pressure  upon  the  viscera, 
and  is  followed  by  a  return  of  normal 
peristalsis  and  bowel  evacuation.  In  the 
number  of  cases  where  this  method  has 
now  been  used  the  results  have  been 
uniformly  satisfactory;  in  some  a  com- 
plete elimination  of  constipation  is  ap- 
parent, and  in  the  worst  cases  this  simple 
safe  procedure  has  given  rehef  unattained 
by  other  means,  and  abdominal  distress, 
gas  accumulations,  signs  of  toxic  absorp- 
tion, headaches,  dizziness,  insomnia,  and 
the  various  symptoms  of  autointoxica- 
tion, now  generally  recognized,  have  been 
overcome.  Particularly  following  plastic 
nonseptic  operations,  the  later  formation 
of  bands  and  adhesions  is  prevented  and 
thereby  potent  causes  of  post-operative 
intestinal  obstruction  and  kinking,  ab- 
dominal pain,  and  chronic  constipation 
obviated. 


90  TREATMENT   OF 

"The  method  commends  itself  as  a 
prophylactic  measure,  the  oil  to  be  used 
inmmounts  of  from  6  to  10  ounces,  just 
before  concluding  many  abdominal  opera- 
tions, especially  in  those  cases  where 
visceral  trauma  and  irritation  have  been 
greater  than  usual  and  in  which  the 
habihty  to  adhesion  formation  and 
kinking  exists.  Not  infrequently  con- 
stipation, absent  prior,  is  present  after 
abdominal  procedures  and  may  be  at- 
tributed to  these  factors  which,  with 
the  use  of  oil,  are  made  non-effective. 

"That  oil  thus  used  is  harmless  has 
been  shown  by  the  writer  through  nu- 
merous animal  investigations,  and  its  ef- 
fectiveness in  the  treatment  of  chronic 
constipation  is  proved." 

There  are  four  contra-indications^^  for 
the  intra-abdominal  use  of  liquid  petro- 
latum: 

"1.  Infection,  whether  this  be  present 
previous  to  or  occur  during  operation 

"£.  Gall-bladder  surgery  where  a  rapid 
formation  of  adhesions  prevents  leakage. 

^BuBKOWs,  New  York  Medical  Record,  1915,  July  10,  pp. 
66.  67. 


<«o 


INTESTINAL  STASIS  91 

3.  In  operations  .  .  .  demanding  firm 
peritoneal  union,  oil  should  not  be  intro- 
duced until  the  surfaces  it  is  intended 
should  adhere  have  been  carefully  placed 
in  contact  and  sutured. 

''4.  The  use  of  oil  intra-abdominally 
should  not  be  the  means  for  avoiding  the 
after-effects  of  crude  or  careless  surgery." 

(D)  To  prevent  or  mitigate  post-anws- 
thetic  nausea  and  vomiting, 

Robert  H.  Ferguson  ^^  in  his  paper 
read  before  the  New  York  Society  of  An- 
aesthetists, after  proving  that  olive  oil  by 
mouth  is  of  no  value  in  preventing  or 
lessening  post- anaesthetic  ether  vomiting, 
since  it  is  saponified  and  digested,  thus 
releasing  in  the  system  whatever  ether 
it  absorbed,  calls  attention  to  the  value 
of  heavy  hquid  petrolatum  for  this  pur- 
pose, since  it  is  not  absorbed  and,  "if 
given  in  sufficient  quantities  (as  soon 
after  the  anaesthesia  as  the  patient  can 
swallow  or  by  stomach  tube  before  con- 
sciousness is  regained),   will  slowly  but 

^New  York  Medical  Journal,  1912,  June  29,  pp.  1359-1360. 


m  TREATMENT  OF  INTESTINAL  STASIS 

surely  pass  through  the  ahmentary  canal, 
and  take  with  it  any  ether  it  may  meet 
along  its  way,  holding  it  in  suspension 
until  it  is  evacuated  at  the  anus.  The 
more  slowly  the  liquid  petrolatum  passes 
through  the  gastro-intestinal  tract  the 
better;  therefore,  the  higher  the  viscosity 
of  the  oil,  the  more  satisfactory  is  the 
result." 

(E)  As  a  post-surgical  laxative. 

Finally,  Bainbridge^^  says:  "The 
after-care  of  the  patient  is  important  in 
all  cases,  but  particularly  so  when  ileo- 
colostomy  and  colectomy  have  been  per- 
formed. .  .  .  An  ounce  of  liquid  petro- 
latum is  administered  by  the  mouth 
three  times  a  day,  as  long  as  may  be 
necessary." 

^"  American  Journal  of   Gastro-Enterology,  1913,  July,  pp. 
13,  14. 


INDEX 


PAGH 

Abdominal  pads  wet  with  liquid  petrolatum 86,  88 

distress  after  operations.     How  to  prevent 86,  89 

support  in  stasis 45,  46,  48 

Abraded  surfaces,  absorption  of  poisons  by 65 

Absorbable  material  in  rectum 30 

Absorption  active  in  csecum 31 

active  in  ileum 63 

beyond  splenic  flexure 30 

boimded  by  splenic  flexure 30 

of  fats  and  oils 11 

of  fliiids  in  large  bowel 30 

of  liquid  petrolatum  by  peritoneum. .  .  , 88 

of  poisons  hindered  by  Uquid  petrolatTim 65 

of  toxins  when  traumatism  exists 25,  26 

how  to  prevent 64,  87 

result  of 19,  20  seq.,  32 

Accommodative  power  of  lens  improved  by  liquid  petrolatum  56 

Acid  bodies 6 

carbohc  on  peritoneum 87 

glacial  acetic.     Effect  of  on  ascaris  lumbricoides 47 

Action  of  liquid  petrolatum  in  stasis 47,  63 

gauged  by  X-ray 59,  60,  67 

Adequacy  of  non-surgical  treatment 37,  38,  40,  47,  50 

See  "Non-Siirgical" 

Adhesions  prevented  by  liquid  petrolatum 83,  88,  89 

Advertised  emulsions,  Pritchard's  warning  against 79,  80 

Agar-agar 45,  51 

Agreeable  taste  desirable  for  liquid  petrolatum 70 

Alcohol  on  peritoneiun 87 

Alimentary  toxaemia  due  to  simple  chemical  substances ....  25 

Alkahne  wastes 63 

Alkaloidal  nature  of  toxins 25 

American  mineral  oils 4 

Ansesthetic  nausea  and  vomiting.     Prevention  of 91 

Angulations  in  intestine.     How  to  straighten 89 

Animal  fats  are  digested 62 

fats  and  oils  vs.  liquid  petrolatum 11 

Anthracene 6 

Antiperistalsis  lessened  by  liquid  petrolatum 67 

shown  by  X-ray 67 

stimulated  by  laxatives 66,  67 

in  large  intestine 30 

Antitoxic  diet  (See  also  "Dietetic  Treatment") 69 

dietary  combined  with  liquid  petrolatum 38 

Antitoxic  ferments 69 

Aperient  drugs  superseded 71 

drugs,  suspension  of 49 

Apparent  vs.  true  viscosity 5 

Appendicitis  caused  by  stasis 21,  67 

reUeved  by  liquid  petrolatum 57 

Appendix,  Auerbach's  tissue  in 53 

Arthritis 22 

Ascaris  lumbricoides,  eggs  of,  divide  in  glacial  acetic  acid ...  47 

killed  by  liquid  petrolatum 47 

93 


94  INDEX 

PAGE 

Ascending  colon,  Auerbach's  tissue  in 53 

sphincter  in 31 

Ascent  of  organisms  in  intestine 84 

Aseptic  absorption  of  food 26 

Asthenic  type  of  build 42 

Atony  not  cause  of  stasis 53 

Auerbach's  Ueo-cascal  collar 53 

plexus.     See  "Myenteric  Ganglia" 12,  51,  52 

at  colonic-rectal  junction 53 

at  distal  colon 53 

at  duodeno-jejunal  junction 53 

at  Ueo-CBecal  junction 53 

at  proximal  colon 53 

at  pylorus 53 

function  of 51 

nodal  centers  of 52 

tissue 52 

in  appendix 53 

in  csBCum 53 

in  colon 53 

Auriculo- ventricular  bundle 52 

Autointoxication  lowers  resistance 84 

and  constipation 25 

from  intestinal  tract 18,  19 

how  to  prevent  after  operation 89 

in  stasis,  cause  of 24 

without  constipation 30 

Avoidance  of  intestinal  stasis  a  ' '  prophylactic ' '  and  ' '  cure  "  17 

Bacillus  bifldus 69 

Bulgaricus 69 

glycobacter 69 

Bacteria  enter  the  blood  stream 24,  25 

from  intestine  may  invade  ducts 19,  20 

growth  of,  inhibited  by  liquid  petrolatum 5,  13,  60 

in  intestine.     Threefold  result  of  stasis  on 19 

production  of  in  intestine 31 

Bacterial  action  and  toxins  in  colon 63 

destruction  of  residues ^ 27 

toxins 27,  63 

Bainbridge,  Wm.  Seaman 20,  32,  34,  70,  83,  92 

Bands,  how  to  prevent  post-operative 89 

Basic  bodies 6 

Best  liquid  petrolatum 4 

Bile  acids 63 

Birds  and  liquid  petrolatum 47 

Bismuth  meal,  progress  of,  with  and  without  liquid  petrolatum  59 

salts  with  Uqmd  petrolatum 76 

Blake,  Gerald 50 

Body-drainage,  importance  of 32 

Body-temperature  the  clinical  standard  for  viscosity 14 

Body  tissue,  stasis  and  vitality  of 33 

waste.     Importance  of  removal 33 

Bogart,  J.  Bion 45 

Bowel-distension,  relief  from 51,  89 

Bowel-flushing 46 

Bowel-movements,  how  controlled 53 

overgrowth  in  length  from  overfeeding 58 

regularity,  false  impressions  of 31 

Bowels  of  parturient  woman.     How  to  regvilate 81,  82 

of  pregnant  woman,  care  of 80,  83 


INDEX  95 

PAGE 

Breast,  degenerative  changes  in 21 

Bulk  of  liquid  petrolatum  imaltered  by  passage  through  body  48 

Burrows,  Montrose  T 32 

BiuTOWS,  Waters  P 86,  87,  88,  90 

CiBCUM,  active  absorption  in 31 

Auerbach's  tissue  in 53 

Califomian  crude  oil 4 

liquid  petrolatum 6 

Cancer  of  pancreas,  gall  bladder,  etc 84 

Care  of  bowels  in  pregnancy  and  lactation 80,  81,  82 

Careless  surgery,  liquid  petrolatum,  no  substitute  for 91 

Carrel,  Alexis 32,  33 

Cascara  sagrada  in  intestraal  stasis 45 

Case,  James  T 67 

Cases  of  ocular  change  benefited  by  liquid  petrolatxun 55 

Castor  oU  contraindicated  for  repeated  use 78 

Catarrh,  chronic  intestinal 26 

Cathartics  and  liquid  petrolatum 49 

and  nursing  child 80,  81 

in  intestinal  stasis 45,  46,  69 

Causes  of  infection  in  stasis 27 

Central  nervous  system,  how   it   controls   movements   of 

bowel 53 

Change  of  flora  and  liquid  petrolatum 69 

Characteristics  essential  to  a  good  mineral  oil 12 

Child,  laxatives  for  mother  afEect  nursing 81 

Children,  constipation  of 73 

Choice  of  suitable  liquid  petrolatum.     How  made 13 

Chronic  colitis,  Uquid  petrolatum  for 64 

intestinal  catarrh  and  toxaemia 26 

intestinal  stasis.     See  "Stasis,"  "Constipation" 

is  the  cause  of  disease 17 

Chrysene 6 

Clark,  Ernest 54 

Clark's  cases  of  ocuJar  changes 55 

Classification  of  cases  of  intestinal  stasis 22 

Clinical  value  of  Mght  and  heavy  mineral  oils 12 

of  oils,  comparative 12 

Coffey,  Robert  O 36,  85 

Colectomy,  post-operative  care  of 92 

when  indicated 45 

Colitis 67 

cure  for 64,  65,  66,  82 

in  infants,  cause  of 78 

in  the  insane 82 

liquid  petrolatum  for 62,  64,  65 

mucous 82 

Colloid  poisons,  intestinal 65 

Colocynth  not  to  be  used  in  stasis 45 

Colon,  absorption  active  in 63 

absorption  of  water  from 61 

destruction  of  residues  in 27 

marked  activity  of  ascending 31 

mechanical  elongation  of 29 

most  efficient  lubricant  for 50 

normal  hypertonus  of  transverse  and  distal 53 

relative  putrefaction  and  absorption  in 63 

toxic  bacterial  activity  in 63 

treatment  when  whole  is  involved 36 

Color  of  stools,  what  due  to 64 


96  INDEX 

PAGB 

Commercial  liquid  petrolatum  not  to  be  used  on  peritoneum  87 

Com.pound  licorice  powder  in  intestinal  stasis 45 

Concentrated  diet,  effects  of 62 

Constipation.     See  also  "Intestinal  Stasis"  and  "Stasis" 

after  abdominal  procedures 90 

aggravated  by  laxatives 65 

and  autointoxication 25 

change  flora  to  overcome 69 

how  to  prevent  post-operative S9 

illness  of  infants  from 72 

importance  of  avoiding 17,  18 

infants'  death  from 72 

is  not  always  stasis 30 

liquid  petrolatum  for  chronic 61 

of  children  and  infants 72,  73 

overcome  by  liquid  petrolatima 50 

postpartum , 81,  82 

reUef  from,  is  curative 50 

spasticity  in 53,  54,  65 

treatments  contra-indicated  in 78 

why  Increased  after  laxatives 68 

with  daily  movements 28 

with  diarrhea 31 

Contra-indications  for  intra-abdominal  use  of  oil 90 

for  surgery  in  s  asis 39 

Cream  in  feeding  of  infants 72 

Criterion  for  judging  Uquid  petrolattun 12,  13 

Crude  mineral  oil,  Cahfomian 4 

Russian 4 

Crude  surgery,  Uquid  petrolatum  no  substitute  for 91 

Crystalline  lens,  liquid  petrolatiun  prevents  senile  changes  in  55 

Danger  in  emulsion  with  hypophosphites 80 

Dangerous  forms  of  treatment  in  stasis 46 

Death  due  to  constipation 72 

imnecessary 33 

Decay  due  to  non-eUmination 33 

Decomposition  of  fcsces  not  from  constipation 26 

Defecation,  early  training  for  proper 78 

mechanism  of 77 

Definition  of  intestinal  stasis 18 

Degeneration,  mammary 21 

Dentistry  and  Uquid  petrolatiun 57 

Denudation,  effect  on  filtration 65 

Descending  colon,  Auerbach's  tissue  in 53 

Destruction  of  parasites  by  Uquid  petrolatum 47 

Diarrhea  of  constipation 31 

Diet,  effects  of  concentrated 62 

for  constipated  infants 73 

Dietetic  treatment  of  stasis 9,  35,  36,  37,  39,  42,  44,  71,  85 

Differentiation  of  cases  by  Uquid  petrolatiun,  .34,  36,  37, 84,  85 

Digestion  disturbed  by  oil  of  low  viscosity 13 

of  fats  and  oils 11 

of  infants  n  t  disturbed  by  Uquid  petrolatmn 72 

Disease  due  to  overfeeding  in  infancy 58 

Distension  of  bowel,  reUef  from 51,  87 

Distribution  of  mineral  oil  in  intestine 5 

Disturbance  of  nutrition  and  digestion.     None  from  Uquid 

petrolatum 72 

Dixon.  W.  E 25 

Dizziness,  how  to  prevent  post-operative 89 


INDEX  97 

PAOB 
Dosage  of  liquid  petrolatum. . .  ,36,  43,  46,  49,  50,  51,  61,  73, 

76,  80,  87,  88,  90,  92 

intra-abdominally 87,  88,  90 

of  Pritchard's  emulsion 76 

Doses  of  Uquid  petrolatiun  for  infants  and  children 80 

Doubtful  cases  of  stasis,  how  to  differentiate 34 

"Drainage  scheme,"  if  efBcient,  prevents  stasis 41 

importance  of 28,  41 

Dressing  for  woimds,  Uquid  petrolatum  as 64 

Dribbling  from  mineral  oils  of  low  viscosity 5,  70 

Drugs,  germicidal,  tonic,  et  al.,  not  to  be  used  in  stasis.  .45,  46 

Duct,  infection  of  biliary 84 

infection  of  pancreatic 84 

Duodenal  kinks 83,  84 

Duodenum,  lumen  of,  reduced  in  calibre 48 

ulcer  of 48 

du  Pasquier 72 

Dysentery  in  animals  ciu:ed  by  liquid  petrolatum 47 

Dyspepsia 23 

Dysperistalsis  in  infants 79 

Early  training  for  efQcacious  defecation 77,  78 

Easton,  P.  G 73 

Ebeling,  Albert  H 33,  34 

Effects  of  slowly  and  rapidly  flowing  oils 13 

Eflacient  "drainage  scheme"  prevents  intestinal  stasis 41 

Eggs  of  ascaris  lumbricoides  divide  in  glacial  acetic  acid ...  47 

killed  by  liquid  petrolatum 47 

Elimination,  effect  of  hindrance  to 33 

of  waste  and  longevity 33 

Elongated,  brittle  stools  from  infants 74 

Elongation  of  colon  and  rectmn 31 

Enteroptosis  vs.  autoiatoxication 29 

benefited  by  Uquid  petrolatum 49 

Entero-spasm  in  infants 79 

EpitheUum,  effect  of  liquid  petrolatum  on  abraded 65 

intestinal,  easily  damaged 78 

of  intestine,  filtering  powers  of 65 

Essential  characteristics  of  a  good  mineral  oil 12 

Ether  suspended  throughout  gut  by  Uquid  petrolatum 92 

Excitable  musculature  of  intestine 52 

Eye  changes  caused  by  intestinal  stasis 55 

F^ajCAL  retention  coincident  with  daUy  movements 28 

Fseces,  decomposition  of,  not  due  to  constipation 26 

organisms  in 46,  48 

quantity  reduced  by  Uquid  petrolatum 46,  48 

rapid  passage  of,  reduces  urine 48 

reduced  ia  bulk  by  Uquid  petrolatum 48 

retention  in  pelvic  colon 31 

softening  of 11,  12 

FaUure  of  non-surgical  means  the  indication  for  surgery .38,  42 

Fat  dyspepsia,  how  induced  m  infants 74 

how  prevented  in  infants 74 

in  infants'  food 74 

Uquid  petrolatum  a  substitute  for 72 

percentage  of,  in  infant  feeding 72 

Fats  and  oils,  digestion  and  absorption  of 11,  62 

vegetable   and   animal,    differ   from   mineral   oil  11 

animal  and  vegetable  do  not  change  stools 62 

laxative  nature  of 62 


98  INDEX 

PAGE 

Feeding  of  infants,  cream  for 72 

Ferguson,  Robert  H 91 

Fermentation  from  stagnation 29 

Filtering  powers  of  epitlieliiim  of  intestine 65 

Finai  effects  of  sm'gical  intervention  unknown 38 

Fissure,  new  and  old,  relieved  by  Mquid  petrolatum 67 

Flatulence 51 

Float  gas-filled  loops  of  gut,  how  to 89 

Flora,  liquid  petrolatum  in  changing 69 

of  intestine,  how  changed 69 

Flushing  of  bowel 46 

Foetus  affected  by  cathartics  for  mother 81 

Food,  aseptic  absorption  of 26 

residues,  abnormal  dryhiS  of 62 

too  long  retention  of 62 

Foodstuffs  in  intestine,  time  of,  reduced  by  liquid  petrolatum  68 

Frequency  of  stools  no  evidence  of  stasis 28 

GAUi-BLADDEB  surgery,   oil  n:t  to  be  used  if  adhesions 

desired 90 

Gallstones,  why  produced 84 

Ganglia,  myenteric,  effect  of  liquid  petrolatum  on 12 

Gaseous  distension  of  infant  bowel  produces  stasis 41 

Gastric  lavage  for  stasis  not  good 46 

General  practitioner  can  prevent  stasis 38 

should  ehminate  .stasis 41 

Germicidal  drugs  condemned  for  stasis 46 

Glacial  acetic  acid  and  ascaris  lumbricoides 47 

Glycerine  suppositories  contra-indicated  for  repeated  use . .  78 

Goitre  and  intestinal  stasis 20,  21 

and  hquid  petrolatum 20 

Hates,  WrLLiAii  Vaj?  Y 36,  44,  85 

Headaches,  how  to  prevent  after  operation 89 

Heavy  mineral  oil  (liquid  petrolatum) 4,  12 

Hemorrhoids  of  pregnancy.     How  to  prevent 82 

reheved  by  hquid  petrolattrai 51,  67 

surgery  for,  lessened  by  Mquid  petrolatum 68 

Hertz,  A.  F 28,  36,  56 

High  natural  viscosity,  importance  of 5,  12,  13,  14,  34,  70 

specific  gravity,  value  of 34 

viscosity  at  body  temperature,  value  of 14 

viscosity  prevents  dribbling 5,  70 

Hippocrates  and  constipation 17 

His,  bundle  of 52 

Hydrocarbons,  injiirious  in  liquid  petrolatum 6 

methane  or  paraffin  series  of 4 

naphthene  series  of 4 

Hygienic  treatment  of  stasis 9,  35,  36,  39,  42,  44,  51,  71 

Hypertonicity,  hquid  petrolatum  in 54 

of  transverse  and  distal  colon 53 

the  cause  of  stasis 53 

Hypophosphites  not  necessary  for  infants 80 

iLEOCiECAL  junction,  nodal  center  at 52,  53 

m.ovements,  origin  of 53 

valve,  how  spasm  of.  is  overcome 67 

incompetency  of 63,  66 

spasm  of 67 

Ileo-colostomy,  post-operative  care  of 92 

Ileo-sigmoidostomy 45 


INDEX  99 

PAOB 

Ileum,  active  absorption  in 63 

infection  from 27 

motility  of,  increased  by  liquid  petrolatum 67 

obstruction  at  end  of 48 

putrefaction  in 63 

toxic  bacterial  action  in 63 

Impurities  in  some  liquid  petrolatums „ 6 

Index  of  lubricating  power 5,  12 

Indol,  solubility  in  liquid  petrolatum 64 

Infancy  and  stasis 58 

indigestion  during,  a  cause  of  stasis 41 

Infantile  distress  from  purgation  of  mother 81 

Infant  nizrsing,  effect  of  purgation  of  mother  on.  .  .  .80,  81,  82 

Infants,  classes  of  stools  in  constipation  of 74 

constipation  of 73 

feeding,  fat  in 72,  74 

illness  from  constipation 72 

nature  of  treatment  of  constipation  in 73 

treatment  of  constipation  in 72,  73,  75  seg. 

Infection  contra-indicates  oU  intra-abdominally 90 

from  ileimi 27 

from  peritonemn,  prevention  of 87 

in  stasis,  causes  of 20,  27 

not  necessarily  an  indication  for  surgery 37 

of  biliary  and  pancreatic  ducts 84 

of  remote  organs,  how  produced 20 

InMbitive  action  of  hquid  petrolatum  on  bacteria 5,  13 

Injurious  hydrocarbons  in  mineral  oUs 6 

Insane,  liquid  petrolatum  for 82 

Insomnia,  how  to  prevent  post-operative 89 

Internal  remedy  for  stasis 10,  44,  57,  61,  71 

Intestinal  functions  after  oi)eration  bettered  by   sitting 

I>osture 86 

intoxication  relieved  by  liqiiid  petrolatum 68 

lubrication  for  treating  stasis 33 

motility,  how  facilitated 67 

mucosa,  result  of  lesions  of 25 

obstruction,  prevention  of 87 

pain,  from  a  rapidly  flowing  oil 13 

paresis,  prevention  of 87 

spasm,  prevention  of 67 

Intestinal  stasis.     See  also  "Constipation"   and  "Stasis." 

a  cause  of  eye  changes 55 

a  condition  for  general  practitioner,  38,  39,  40,  41,  42 

and  appendicitis,  arthritis,  tuberculosis,  cancer,  21,  22 

and  autointoxication 24 

and  bowel-distension  in  infancy 41 

and  liquid  petrolatum 34,  35,  42   {et  al.) 

and  pyorrhoea 57 

definition  of 18 

drugs  in.     See  also  imder  the  name  of  the  drug,  45,  46 

due  to  hypertonicity 53,  54 

importance  of 17 

in  Ochsner's  practice 39 

Lane's  theoiy  of 18,  29 

laxatives  for.     See  also  "Laxatives" 44 

lessens  accommodative  power 56 

liquid  petrolatiim  first 34,  44 

non-surgical  treatment  first 35,  36,  37,  43,  44 

non-surgical  treatment  of,   dietetic,  hygienic,  or- 

thopsedic,  by  internal  lubrication 39,  42,  44 


100  INDEX 

PAGE 

Intestinal  stasis  ought  not  to  become  surgical 39,  41 

postpartum 80,  81,  82 

presented  daily  to  the  physician 23,  43 

rationale  of  treatment 35 

stasis.    See  aZso  "Stasis,"  "Constipation,"  etc.  . ,  19 

to  be  prevented  by  prophylaxis 41 

toxsemia  and  remote  organs 20 

toxins  dissolve  in  Uquid  petrolatura 63 

treated  by  lubrication 33 

treatment     of.       See     "Dietetic,"     "Hygienic," 
"Orthopsedic." 

what  to  do  In  doubtful  cases 34 

with  daily  movements 28 

Intestine,  intestinal.     See  also  "Bowel." 

rate  of  passage  of  mineral  oil  in 5,  13 

Intoxication,  intestinal,  relieved  by  liquid  petrolatimi 68 

Intra-abdominal,  pressure  by  liquid  petrolatum 89 

use  of  Mquid  petrolatima 83,  86,  89 

Iodine  on  peritoneum 87 

Irritation  not  produced  by  liquid  petrolatum 67 

Jackson,  J.  N 30 

Jackson's  membrane 62 

Jones,  N.  W 38,  42 

Jordan,  Alfred  C 69 

Keith,  Arthur 51,  52 

Kellogg,  J.  H 38,  61 

Kidneys,  influence  of  toxins  from  intestine,  on. 49 

Kinks  and  stasis 29,  47,  62,  83,  89,  90 

how  corrected 89 

how  to  prevent  post-operative 62,  90 

Lane's 28,  63 

overcome  by  lubrication 62 

Knight,  A.  L 51 

Lactation.     How  to  regulate  bowels  during 81,  82 

hquid  petrolatum  in , 80,  81,  82 

Lancet  (London)  and  "Viscosity" , 13,  14 

Lane,  Sir  W.  Arbuthnot,  17,  18,  19,  20,  21,  22,  28,  34,  35,  45, 

56,  58,  83,  84 

Lane's  kink 28,  63 

Large  amounts  of  hquid  petrolatum  harmless 60 

Large  intestine,  absorption  of  fluids  in 30 

Laxative  combined  with  liciuid  petrolatum 38 

Laxatives  aggravate  constipation 65 

and  mirsiag  child 80,  81,  82 

contra-indicated 66 

Increase  spasm  of  ileo-csecal  valve. 67 

Increase  spasticity 65 

indirect  action  of,  on  foetus  or  infant 81 

in  stasis 44,  66 

liquid  petrolatum  superior  to 70 

produce  undesirable  antiperistalsis 66,  67 

Leakage  from  mineral  oils 5,  70 

Lens,  changes  in,  prevented  by  liquid  petrolatum 55 

premature  hardening  of 57 

Leshe,  R.  Murray 31,  36,  49,  51.  59,  71,  82 

Light  mineral  oil  (hquid  petrolatiun) 4,  12 

Liquid  paraflQn 10 

Liquid  petrolatum.    See  also  "  Mineral  Oil." 


INDEX  101 


PAGE] 

Liquid  petrolatum,  action  of,  in  stasis 47 

a  cure  for  stasis 57 

agreeable  to  taste  is  best 70 

and  abraded  surfaces 65 

and  dribbling 5,  70 

and  goitre 20,  21 

and  lubrication 12 

and  tuberculosis 58 

an  inert  lubricant 72 

as  a  protective 65 

as  a  surgical  dressing 64 

a  solvent  for  waste  and  toxins 63 

as  protective  of  mucous  membrane 6-1: 

a  substitute  for  meconium 78 

a  vehicle  for  drugs 76 

before  surgei*y  in  stasis .  .  .  .    45 

best  for  stasis 70 

"by  common  consent  the  most  satisfactory" 70 

cannot  decompose 75 

colors  stools  brown  or  black 64 

dissolves  indol 64 

does  not  affect  foetus 82 

dosage.     See  "Dosage." 

effect  of  regular  use  of 49 

first 34,  35,  36,  38,  84.  85 

for  brutes 47 

for  differentiating  cases 34 

for  hemorrhoids  and  fissure , 67 

for  infant  constipation 75 

for  intestinal  stasis 33,  42,  43,  47,  48 

and  many  other  pages 

for  nursing  mother 81,  82 

for  pregnant  woman 81,  82 

harmless  in  peritoneal  cavity 90 

heavy 4,  12 

how  to  select  one  for  internal  use 13 

impurities  of  some 6 

in  aU  doubtful  cases 34,  85 

in.  constricted  gut,  duodenum,  etc 48 

increases  motility  of  small  intestine 67 

in  dentistry 57 

in  hjrpertonicity 54 

in  infancy 58 

innocuous  to  man 48 

in  stasis,  value  of .46  (e^  al.) 

intra-abdominally 86 

irritating  ingredients  in  many  oils 6,  70 

lessens  antiperistalsis 67 

light 4 

mechanical  action  of 46,  50,  62 

most  efficient  lubricant  for  colon 50 

no  infant  nutritional  or  digestive  disturbances ...  72 

no  irritation  from 67 

no  offensive  stools  from 75 

not  absorbed 46,  62,  75  (e<  al.) 

of  high  viscosity  for  post-an£esthetic  use 92 

for  stasis  and  constipation,  3, 4,  5, 13, 14,  70  (et  al.) 

of  market  not  sufficiently  refined 70 

of  naphthene  series 87 

only  superior  quality  to  be  used 70,  92 

passage  through  intestine 6 


102  INDEX 

PAGE 

Liquid  petrolatum,  physiological  working  of 44 

prevents  ascent  of  organisms 84 

proper  viscosity  of . , 14 

pure  viscous  for  peritonemn 87,  88 

pure  viscous,  safe  in  peritoneal  cavity 88 

relieves  irritated  myenteric  ganglia 54 

shortens  time  of  passage  of  gastro-intes.  contents .  59 

slowly  absorbed  by  peritoneum 88 

Squibb 's 4 

Squibb's,  how  sold 6 

Squibb 's,  quality  specifications  of 5 

Squibb's,  specific  gravity  of 5 

Squibb's,  viscosity  of 5,  6 

substitTution  for  fat 72 

surgical  use  of 83 

the  internal  remedy  for  stasis 34,  44,  45  (et  al.) 

the  kind  best  for  internal  use 4 

thin,  not  desirable 70,  90 

to  be  preferred  to  laxatives 70 

to  differentiate  cases 45,  84,  85 

unabsorbed  in  intestine,  etc 11,  48  {et  al.) 

used  early  gives  permanent  rehef 71 

"  useful  in  all  forms  of  stasis  " 62 

uses  of.  See  variotis  uses — as  "infants,"  "surgical,"  etc. 

U.  S.  Pharmacopoeial  name  for  mineral  oil 11 

viscous  for  abdominal  use 89 

for  internal  use 5,  6,  12,  44,  70,  92 

vs.  animal  and  vegetable  fats 13,  62 

vs.  cathartics  and  aperients 49 

vs.  salt  solution 88 

when  and  how  given  post-ansestheticaUy 91 

when  contra-indicated  for  peritonetun 90,  91 

when  to  put  into  abdomen 87 

when  to  use  it  on  peritoneum 88,  89,  90 

with  a  laxative. . , 38 

with  antitoxic  dietary 38 

Liver,  in  infants'  pasty  stools 74 

not  taxed  by  liquid  petrolatmn 75 

Longevity  and  elimination  of  waste 33 

Lose©,  Joseph  R 33,  34 

Low  viscosity  in  mineral  oil  disturbs  digestion 13 

pain  produced  by  oil  of 13 

Lubricants  supersede  aperient  remedies 71 

Lubricating  power,  the  index  of 5,  12 

Lubrication  a  cure  for  stasis 36,  45,  60,  61,  71 

by  liquid  petrolatum 12,  13,  49,  51,  59,  65 

for  intestinal  stasis 35 

for  overcoming  kinks 62 

internally  a  preventive  and  cure  forttuberculosis ....  22,  58 

intra-abdominal 89 

of  intestine 11,  13 

of  whole  alimentary  canal  by  liquid  petrolatimi 61 

steadiness  of,  how  produced 13 

the  chief  value  of  Mquid  petrolatum 13 

the  role  of  Uquid  petrolatum 50 

Maeble-shaped  stools 77 

Massage  for  stasis  condemned 46 

Massage  for  stasis  recommended 36 

Mayo,  Wm.  J 30 

Mechanical  action  of  liquid  petrolatmn 50,  62 


INDEX  103 

PAGB 

Meconium,  value  of 78 

Medical  failures  reserved  for  siirgery 37 

laxatives  contra-indicated 66 

treatment  in  stasis • 39,  85 

Membrane,  Jackson's 62 

Mental  disturbances 23 

Mercury  bichloride  to  peritoneimi 87 

Mesentery  and  stasis 47 

Metctmikoff,  filie 18,  46,  72,  80 

Methane  series 4 

Mineral  oil.     See  also  "  Liquid  Petrolatmn  " 4 

an  inert  lubricant 72 

differs  from  vegetable  and  animal  fats  and  oils. . .  11 

heavy 4,  5,  12 

light 4,  12 

of  high  viscosity  best 5,  12,  13,  14,  70,  89,  92 

proper  viscosity  of 5,  14 

types  of,  for  internal  use 3,  4 

Mineral  oils,  American 4 

light,  leakage  or  dribbling  from 5 

properties  of 4 

study  of,  by  E.  R.  Squibb  &;  Sons 3 

the  kind  best  for  internal  use  defined 4,  12 

Most  stasis  is  non-sm-gical 34  to  41  iet  al.) 

Motility  of  ileum  increased  by  liquid  petrolatum 67 

Motions.     See  also  "Stools." 

character  of,  when  Uquid  petrolatum  is  used 46 

Movements  of  bowel,  how  controlled 63 

Mucosa  intestinal,  autointoxication  from  lesions  of 25 

Mucous  cohtis,  liquid  petrolatum  for 49,  82 

membrane,  changes  in  intestinal 85 

protected  by  liquid  petrolatum 64 

Musculature,  most  excitable  of  intestine 52 

Mutch,  N 26 

Mycosis  of  skin  and  iodine 47 

cured  by  Uquid  petrolatum 47 

Myenteric  ganglia.     See  also  "Auerbach's  plexus." 

at  ileo-csecal  junction 52 

Auerbach's  plexus,  character  of 51,  52 

effect  of  liquid  petrolatum  on 12,  54 

function  of 51 

liquid  petrolatmn  relieves  irritated 54 

originates  and  conducts  impulses 52,  53 

plexus,  nodal  centers  of 52 

reaction  to  stimuli 51,  52 

Name,  official,  in  XJaited  States  for  mineral  oil 10,  11 

Naphthen©  series  of  hydrocarbons 4,   5,  87 

series,  resistance  to  oxidizing  agents 6 

Natural  viscosity.     See  also  "True." 

value  of 5,  14,  34 

Nausea,  post-ansesthetic,  liquid  petrolatum  for 91 

"Nearest  panacea"  for  constipation. 61 

Nervous  system  and  stasis 21 

Neiirasthenia 22 

Nauro-muscular  mechanism,  disorder  of  intestinal 64 

Neurotics  and  stasis 39 

Nodal  tissue  of  auriculo- ventricular  bimdle 62 

Non-elimination  of  toxins,  result  of 33 

Non-surgical  treatment  first 34  to  41,  44  (etal.) 

©f  stasis 23,  36,  38,  40.  43,  44,  45,  48,  85  {et  al.) 


104  INDEX 

PAOB 

Non-surgical  treatment  recommended  by  surgeons 40 

sufficiency  of 35,  40,  47 

vs.  short-circuituig 38 

Normal  peristalsis,  how  restored  after  operation 87 

Nursing  mother,  care  of  bowels  of 80,  81,  82 

how  to  regulate  bowels  of 81,  82 

Obstruction  at  end  of  ileum 48 

Ochsner,  A.  J 17,  39,  41,  43 

Ochsner's  cases,  1914 39 

Ochsner's  experience  with  intestinal  stasis 43 

Ocular  changes  in  stasis,  cases  of  cure 55 

OU,  use  of,  after  infection 90 

Oils  and  fats,  digestion  and  absorption  of 11,  62 

Oils,  vegetable  and  animal,  no  use  for  constipation 75 

OUve  OU,  post-aneesthetic  use  is  of  no  value 91 

saponification  and  digestion  of 91 

Oophoritis 67 

Operative  procedures  for  stasis,  when  to  adopt 34 

only  after  liqxiid  petrolatum 85 

visceral  irritation,  how  to  care  for 90 

visceral-trauma,  how  to  care  for 90 

Ophthalmology,  use  of  liquid  petrolatum  in 55 

Organisms,  ascent  of,  in  intestine 84 

in  feeces 46,  48 

in  intestine,  effect  of  stasis  on 19,  27,  84 

Orthopaedic  treatment  of  stasis,  9,  35,  36,  42,  45,  47,  48,  60,  71 

purpose  of 35 

Oxidizing  agents,  resistance  of  naphthene  hydrocarbons  to.  6 

Pads,  liquid  petrolatum  on  abdominal 86 

Pain  from  rapidly  flowing  oil 13 

intestinal,   See  gZso  "Abdominal." 

post-operative  abdominal 86 

Pancreas  in  infants'  pasty  stools 74 

Pancreatic  emulsion 76 

extract  in  Uquid  petrolatum 76 

Pancreatitis,  cause  of 84 

Paraffin 5,  6,  10 

adulterant  of  Uquid  petrolatum 6 

and  apparent  high  viscosity 6 

series 4 

Parasites  destroyed  by  Mquid  petrolatima 47 

Paresis  of  intestine,  how  to  prevent 87 

Parturient  woman,  how  to  regulate  bowels  of 81,  82 

du  Pasqmer 72 

Passage  of  Uquid  petrolatum  through  intestine 5,  12,  13 

Pasty  stools  from  infants 74 

Patient,  post-operative  care  of,  important 92 

Pediatrician  should  eliminate  intestinal  stasis 41 

Pelvic  colon,  elongation  of 31 

evacuation  of,  not  curative 26 

Percentage  of  surgical  stasis  cases 36,  39,  40,  43,  85 

Perforation  of  intestine  from  constipation 26 

Peristalsis  and  excretion  of  urine 48 

centers  of 52,  53 

how  to  restore  normal  after  operation 89 

in  infants'  pasty  stools 74 

of  Ueima  increased  by  Uquid  petrolatmn 67 

origin  of  movements 51,  52 

Peristaltic  overstimulation  detrimental 78 


INDEX  105 

PAGB 

Peritoneal  union  prevented  by  oil 91 

Persistent  liquid  petrolatum  treatment  before  operating ...  85 

Petroleum 10 

Petroleum  oil 10 

Pharmacopoeia,  U.  S.,  Mineral  oil  of 10 

Phenanthrene 6 

Phenol 6 

Phenolpbthalein  in  intestinal  stasis 45 

Plastic  non-septic  operations,  post-operative  treatment  of  89 

Plexus,  fxmction  of  Auerbach's 51 

Plexus.     See  "Myenteric." 

Policy  of  E.  R.  Squibb  &  Sons 3 

Podophyllin  not  to  be  used  in  stasis 45 

Poisons,  colloid  in  intestine 65 

Post-anaesthetic  nausea  and  vomiting,  liquid  petrolatum  for  91 

Post-operative,  constipation,  prophylaxis  for 90 

intestinal  spasm,  how  prevented 87 

sitting  posture 86 

Post-operative  stasis,  cause  of 86 

surgical  absorption  of  toxins,  how  to  prevent 87 

surgical  stasis,  prophylaxis  for 86 

Postpartum  constipation  and  stasis 80,  81,  82 

Posture  after  abdominal  operations 86 

Potentiality  for  ptosis 42 

Practitioner,  general.     See  "General  Practitioner" 38,  41 

Pregnancy,  liquid  petrolatum  in 81,  82 

Pressure  by  liquid  petrolatum  abdominally 89 

Prevalence  of  intestinal  stasis 23,  42,  43 

Pritchard,  Eric 58.  72,  73,  77 

Pritchard's  emulsions  of  liquid  petrolatiun 76,  79 

experience  with  liquid  petrolatimi 75 

treatment  for  infant  constipation 74 

Prolonged  use  of  liquid  petrolatum 50 

Properties  of  mineral  oils 4,  5,  13,  14 

Prophylaxic  use  of  Uquid  petrolatum 83 

Prophylaxis  for  post-surgical  stasis 86 

for  stasis 41 

Protective  action  of  liquid  petrolattun 59 

Protein  digestion  and  toxaemia 25 

putrefaction 25 

Ptomaines  from  bacterial  action 63 

Ptosis,  amenable  to  non-surgical  treatment 37 

catise  of , 29 

in  relation  to  stasis 29 

surgery  not  indicated  for 37 

Puddling  of  mesenteric  blood  in  stasis 47 

Pxilp,  vegetable  for  stasis 43 

Purgatives,  indirect  action  of,  on  foetus  or  infant 81,  82 

not  to  be  used  in  stasis 46 

Purity  of  liquid  petrolatum  necessary 12,  13,  34,  70 

Purpose  of  administration  defeated  by  "thin"  oil 71 

Putrefaction  from  stagnation 29 

more  active  in  ilemn 63 

of  proteins 25 

Pyorrhoea  benefited  by  liquid  petrolatxun 57 

Quality  specifications.  Liquid  Petrolatum  Sqmbb 5 

Rapid  passage  of  fseces  lessens  urine 48 

Rationale  of  orthopaedic  treatment  in  stasis 47 

Rectal  disease 67 


106  INDEX 

PAGE 

Rectum,  elongation  of 31 

Regularity  of  bowels,  false  impression  of 31 

Regular  use  of  liquid  petrolatum,  benefit  from 49 

Relative  solubility  of  toxios  in  liquid  petrolatum  and  in  water  64 

Relief  from  constipation  curative 50 

Remedy,  the  best  one  for  stasis 71 

Rem.ote  effects  of  intestinal  stasis 19 

of  siu"gery  for  stasis  not  yet  known 38 

Residue,  adherent  pasty  mass  of 62 

Residues,  bacterial  destruction  in  colon 27 

Result  of  stasis  on  intestinal  organisms 19 

Results  from  use  of  liquid  petrolatum 61  seq. 

Rhemnatoid  arthritis 22,  23 

Rhythmic  contractions  of  intestiae,  where  begin 52,  53 

Rockefeller  Institute 32 

Rockey,  A.  E 18,  29,  49 

Royal  Society  of  Medicine,  discussion 40 

RoweU,  George 20,  27,  57.  58 

Russ,  W.  B 37 

Russian  crude  oU 4 

mineral  oU 3,4,  10 

SaIvINB  cathartics  in  intestinal  stasis 45 

Salt  solution  replaced  by  liquid  petrolatum 88 

Saundby,  Robert 25,  28 

Scybala  softened  by  liquid  petrolatxim 73 

Senile  changes  in  lens  prevented  by  Uquid  petrolatum. .  .55,  56 

Senility  unnecessary 33 

Short-circuiting  prevented  by  liquid  petrolatum 70 

vs.  non-surgical  treatment 38 

Sitting  posture  after  abdominal  operations 84 

Skin,  effect  of  liquid  petrolatum  on  parasites  on 47 

mycosis  cured  by  liquid  petrolatum 47 

Small  per  cent  of  ptosis  cases  surgical 37 

Smith,  Rea 37 

Soap  and  water  enemata  contraindlcated  for  repeated  use  78 

Softening  of  intestiaal  contents 65 

Spasm  of  ileo-caecal  valve  a  cause  of  stasis 67 

how  overcome 67 

increased  by  laxatives 67 

Intestinal 67 

Spasmodic  movements  of  bowel  to  be  avoided 50 

Spastic  condition  of  intestine 53,  65 

Spasticity  an  obstacle  in  constipation 65 

incresised  by  laxatives 65 

relieved  by  liquid  petrolatima 66 

Specific  gra^'lty,  affected  by  temperature 14 

and  viscosity,  relative  value  of 12,  13,  14 

necessity  for  a  high 13,  34 

Sqmbb's  liquid  petrolatum 5 

vs.  viscosity 5,  13 

Sphincter  in  ascending  colon 31 

Splenic  flexure,  absorption  beyond 30 

a  boimdary  of  absorption 30 

Sponges  with  Uquid  petrolatima 86,  88 

Squibb,  E.  R.,  &  Sons,  poUcy  of 3 

study  of  mineral  oils 3 

tests  of  mineral  oils 4 

Squibb's  liquid  petrolatum 4,  5,  6 

See  also  "Liquid  Petrolatum  Squibb" 

Stagnation  in  lleuBi  vs.  stasis  ta  colon 63 


INDEX  107 

PAGE 

Stagnation  favors  fermentation 29 

in  small  intestine,  importance  of 63 

Standard  Oil  Company  of  California 4 

Stasis.     See  also  "Intestinal  Stasis,"  "Constipation." 

Stasis  and  goitre 20,  21 

and  hardening  of  lens 57 

and  infancy 53 

and  the  general  practitioner 3S,  41 

and  the  pediatrician 41 

and  vitality  of  body  tissue 3.3 

best  treated  by  liquid  petrolatum. 70 

Stasis,  caused  by  incompetency  of  Ueo-csscal  valve 66 

cause  of  post-operative 86 

frequency  of  stools  no  evidence  against 28 

in  relation  to  ptosis 29 

is  not  absence  of  daily  movements 19 

is  not  constipation 30 

may  begin  in  infancy 41 

most  cases  non-surgical 36,  40  (et  al.) 

post-operative,  how  prevented 86,  88 

the  most  valuable  remedy  for 71 

with  daily  evacuations 31 

Steadiness  of  lubrication,  how  produced 5,  13 

Stimulation  by  hquid  petrolatimi 62,  63 

of  acti\-ity  of  small  bowel 63 

of  intestinal  epithehmn 78 

Stools,  character  of  with  hquid  petrolatum 46 

colored  by  liquid  petrolatum 64 

daily,  yet  stasis 31 

elongated,  hard  and  brittle 74 

foul  odor 74 

frequency  of,  no  evidence  of  stasis 28 

greasy 74 

infants 74:  {et  al.) 

Ught-colored 74 

marble-shaped 77 

not  offensive  from  hquid  petrolatum 75 

pasty 74 

temporary  relief  from  wateiT 66 

Straighten  out  angulations,  how  to 89 

Strasburger 46 

Study  of  mineral  oils,  E.  R.  Squibb  &  Sons 3 

Sufficiency  of  non-surgical  treatment  of  stasis 35 

Suitable  liquid  petrolatum  for  internal  use 13,  14 

Sulphur  compoimds  undesirable  in  miaeral  oils 6 

in  liquid  petrolatum 76 

Superior  quahty  of  Hquid  petrolatmn  necessary,  5,  14,  44,  92 
Supports  for  intestinal  stasis.    See  "Orthopaedic" 

35,  36,  45,  46.  48.  60 

Suppositories,  glycerine,  contraindicated  for  repeated  use . .  78 

Surgery  for  hemorrhoids  lessened  by  Uqxiid  petrolatum ....  68 

for  intestinal  stasis,  when  to  adopt 34 

not  for  ptosis 37 

not  indicated  by  infection  or  toxaemia 37 

for  stasis 36  (ef  al.) 

only  after  faUm-e  of  non-surgical  treatment 42 

only  after  non-surgical  means  fail 38 

seldom  indicated  ui  stasis 39 

Surgical  cases,  how  to  differentiate 36,  84,  85 

of  stasis 23 

percentage  of 39,  40 


108  mDEX 

PAGE 

Surgical  dressing,  liquid  petrolatum  for 64 

treatment  only  after  medical 41 

use  of  liquid  petrolatum 83  seq. 

Tawaba 52 

Temperature  affects  specific  gravity 14 

affects  viscosity 14 

Tests  of  mineral  oils,  E.  R.  Squibb  &  Sons 4 

Therapeutic  action,  no  iajurious  results  from 75 

Thin  liquid  petrolatum  undesirable 5,  13,  14,  70,  92 

Thyroid  enlarged  and  intestinal  stasis 20,  21 

relation  of  intestinal  stasis  to 20 

Time  required  for  action  of  liquid  petrolatum 61 

Tissue,  Auerbach's 52 

Tonic  contraction  of  colon 53,  54 

Tonics  not  of  value  in  stasis 46 

Tormia  in  infants 79 

Toxaemia  and  chronic  intestinal  catarrh 26 

and  intestinal  stasis 22 

and  results  of  intestinal  stasis 20 

and  ulceration,  perforation,  chronic  intestinal  catarrh, 

constipation,  etc 24,  26 

causes  of,  in  intestinal  stasis 27 

from  digestion  of  proteins 25 

not  an  indication  for  surgery 37 

without  interference  with  peristalsis 30 

Toxic  absorption,  how  prevented 63,  65,  89 

Toxins  absorbed  by  mesenteric  vessels,  effect  of 49 

absorption  of  prevented  by  liquid  petrolatum. . .  63,  64,  89 

absorption  of  when  traumatism  exists 25 

alkaloidal  nature  of 25 

and  bacterial  action  in  colon 63 

bacterial 27 

dissolved  by  liquid  petrolatum 63 

due  to  bacterial  action 63 

from  bacterial  activity 24 

from  normal  digestion 24 

from  peritoneal  cavity 87 

of  intestine,  nature  of 25,  63 

production  of  in  intestine 25,  26,  31 

result  of  absorption  of 33 

result  of  non-elimination  of 33 

Transverse  colon,  Auerbach's  tissue  in 63 

Trauma  of  viscera,  how  to  care  for  after  operating 90 

Traumatism,  cause  of  absorption  of  toxins 25,  65 

of  epithehmn,  effect  of  Uquid  petrolatum  on 65 

of  gut,  how  to  overcome  effects  of 86 

the  cause  of  toxsemia 25 

Treatment  of  stasis,  dietetic,  hygienic,  internal,  orthopaedic, 

9,  28,  35,  36,  37,  42,  71,  85 

non-surgical.     See  also  "  Non-Sm-gical " 43 

non-surgical  first 44 

in  stasis,  dangerous  forms  of 46 

imanimity  of  opinion  on 44 

True  viscosity.     See  "Natural,"  "Viscosity" 5 

Tuberculosis  caused  by  intestinal  stasis 21,  22 

prevented  by  internal  lubrication 58 

Types  of  mineral  oil  for  internal  use 3,  4,  14 

Ulcee  of  duodeniun 48 

Ulceration  of  intestine  and  toxaemia 26 


INDEX  109 

PAGE 

Unanimity  of  opinion  on  treatment 44 

United  States  Pharmacopoeia,  mineral  oil  of !  10 

'*  Universal  remedy  "  for  stasis 60 

Urine  excretion "of  and  peristalsis [  43 

influence  of  absorbed  toxins  on 49 

quantity  of,  reduced  by  liquid  petrolatum 48 

Use  of  liquid  petrolatimi,  prolonged 60 

Value  of  liquid  petrolatxmi  in  stasis 44,  45,  57,  71 

Valve,  incompetency  of  ileo-csecal 63 

Vegetable  fats,  absorbed 62 

and  oils  vs.  liquid  petrolatum 11,  62 

pulp  for  stasis 43 

Vehicle  for  drugs 75,  76 

Veterinary  use  of  Uquid  petrolatumi 47 

"  Vicious  cycle ' '  ia  stasis 32 

Visceral  irritation  from  operation,  how  best  cared  for 90 

Visceral  tratmaa,  how  treated  after  operation 90 

Viscosity  affected  by  temperature 14 

apparent  vs.  true 5 

and  leakage  (dribbhng) 5,  70 

and  London  Lancet 13 

and  specific  gravity,  relative  value  of 5,  12,  13 

high  for  oil  for  use  after  anaesthesia 92 

high,  low,  effects  on  digestion 13 

high,  necessary  to  prevent  dribbUng 5,  70 

natural 5,  14,  34 

natural,  importance  of 14,  34 

of  mineral  oil 4 

of  mineral  oil  at  body  temperature 14 

of  Squibb 's  Uquid  petrolatum 4,  5 

relative  pain  producing  power  of  oils  with  high,  with 

low 13 

the  index  of  lubricating  power 5,  12,  13 

the  mineral  oil  of  highest 6 

value  of  high 13,  92 

vs.  specific  gravity 5,  12,  13 

Vomiting,  post-ansesthetic,  liquid  petrolatum  for 91 

how  to  prevent 88 

Water,  excessive  absorption  of,  from  colon 61 

to  prevent  dryness  of  contents  of  colon 49,  50 

Watery  stools,  temporary  reUef  from 66 

Watson,  D.  Chalmers 22,  43 

Watson's  observations 22,  23,  24,  43 

Weight,  increase  in  infants 74 

What  liquid  petrolatmn  is  best  for  internal  use. .  .4,  12,  13,  14 

When  to  introduce  Uquid  petrolatum  into  abdomen 87 

not  to  introduce  Uquid  petrolatmn  into  abdomen. .  .90,  91 

White,  W.  Hale 38,  40 

Wide-spread  existence  of  intestinal  stasis 42 

Wooley,  Paul  G 24 

Worms  in  intestinal  track,  effect  of  liquid  petrolatum  on. . .  47 

X-RAY  and  antiperistalsis 67 

and  Uquid  petrolatmn 59,  60,  67 

gauges  action  of  Uqmd  petrolattmi 59 

shows  eflQcacy  of  Uquid  petrolatum 60 


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SQUIBB'S 

MATERIA  MEDICA 


A  Complete  Descriptive  List  of 
the  Squibb  products,  embracing 
the  articles  in  the  U.  S.  Pharmaco- 
poeia and  the  National  Formulary, 
together  with  approved  non- offi- 
cial Remedies  in  general  use, 
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Biological  Products.  Setting  forth 
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